The Patients’ Rights Charter and patient centered 
care in a South African hospital 

 
 

 

 

 

 

 

 

Ipeleng Patience Nku 

WITS Business School 
 

 

 

 

 

 

 

 

Thesis presented in partial fulfilment for the degree of Master of 

Business Administration to the Faculty of Commerce, Law, and 

Management, University of the Witwatersrand 
 

August 2021 
  



 ii 

DECLARATION 
 
I Ipeleng Patience Nku declare that this research report entitled ‘The Patients’ Rights 

Charter and patient centered care in a South African hospital’ is my own unaided work. 

I have acknowledged, attributed, and referenced all ideas sourced elsewhere. I am 

hereby submitting it in partial fulfilment of the requirements of the degree of Master of 

Business Administration at the University of the Witwatersrand, Johannesburg. I have 

not submitted this report before for any other degree or examination to any other 

institution. 

 

 

Ipeleng Patience Nku  

Signed at Johannesburg on 29th August 2021  

 
 

Name of candidate Ipeleng Patience Nku 

Student number 306444 

Telephone numbers 073 879 2995 

Email address Ipelengnku@gmail.com 

First year of registration 2020 

Date of proposal submission 15 January 2021 

Date of report submission 31 August 2021 

Name of supervisors Samukelo Ngubane and Kambidima Wotela 

 





 iii 

ABSTRACT 
 
Author: Ipeleng Patience Nku Supervisor Samukelo Ngubane 

Thesis title: The Patients’ Rights Charter and patient centered care in a South 

African hospital 

 

South Africa’s historical context has resulted in significant disparities and challenges in 

its healthcare sector. The national Patients’ Rights Charter was developed to counter 

these challenges by empowering patients and protecting their rights. Nevertheless, 

majority of patients attending hospitals remain unaware of their rights, and as a result 

face many frustrations associated with the quality of healthcare they receive. 

 This research seeks to assess patients’ perceptions on the Patients’ Rights Charter and 

the influence that it has on the concept of patient centered care in a public South 

African hospital. Making use of three components of the Patients’ Rights Charter, 

namely confidentiality, informed consent and patient participation in decision making, 

the extent to which the rights are perceived by patients will be explored. The goal of this 

study is to assist hospitals in and around South Africa to improve patient centered care 

through use of the Patients’ Rights Charter.  

The study employed a quantitative research approach making use of fully structured 

questionnaires. With 200 participants observed from the medical and surgical out 

patients departments of the Tembisa Provincial Tertiary hospital, results revealed that 

86% were aware that they have rights as patients, while only 31% were aware of 

existence of the Patients’ Rights Charter. Overall the research found that patient 

perceptions of the Patients’ Rights Charter were favourable. Correlation analysis 

revealed that all three constituents had a positive relationship with patient centered care, 

while multiple linear regression analysis found that only patient participation and 

informed consent directly influenced patient centered care. Thus laying focus on 

improving implementation of the Patients’ Rights Charter can aid hospital management 

in enhancing patient centered care. Such improvement in implementation would best be 

achieved through collaborative efforts of different systems and areas of the hospital. 

Key words: Patients’ Rights Charter, patient centered care, confidentiality, informed 

consent, participation in decision making. 

Johannesburg, August 2021 



 iv 

TABLE OF CONTENTS 

 
DECLARATION ....................................................................................................................................... ii 
Abstract iii 
Table of contents ....................................................................................................................................... iv 
List of tables vii 
List of figures viii 
ACKNOWLEDGEMENTS ................................................................................................................... ix 
Definition of key terms and concepts ..................................................................................................... x 
1 Chapter One – Background and Introduction ............................................................................ 11 

1.1 Background ................................................................................................................................ 11 
1.1.1 The South African Healthcare Industry .................................................................. 11 
1.1.2 Patient Centered Care (PCC) .................................................................................... 12 
1.1.3 The Patient Rights Charter (PRC) ........................................................................... 12 

1.2 Research Conceptualisation ..................................................................................................... 13 
1.2.1 Research Problem Statement .................................................................................... 13 
1.2.2 The Research Aims and Objectives ......................................................................... 14 
1.2.3 The Research Questions and Hypotheses .............................................................. 15 

1.3 Research Delimitations and Assumptions of the Research Study ..................................... 16 
1.4 Research Significance ................................................................................................................ 16 
1.5 Preface to the research report ................................................................................................. 17 

2 Chapter two - Literature review ..................................................................................................... 18 
2.1 Problem analysis ........................................................................................................................ 18 

2.1.1 Societal Impact of Disease and Public Healthcare ................................................ 18 
2.1.2 Patient Centered Care Defined ................................................................................ 19 
2.1.3 Patient Rights Charter Defined ................................................................................ 20 
2.1.4 Implementation of the PRC and PCC .................................................................... 21 
2.1.5 Healthcare management ............................................................................................ 21 
2.1.6 Institutional theory ..................................................................................................... 22 
2.1.7 Implementation Theory ............................................................................................. 23 
2.1.8 Systems Theory ........................................................................................................... 24 
2.1.9 Overall Economic Impact on Healthcare Services ............................................... 24 

2.2 Research knowledge gap analysis ............................................................................................ 25 
2.3 Quantitative variables key to research .................................................................................... 27 

2.3.1 Patient centered care .................................................................................................. 27 
2.3.2 Confidentiality ............................................................................................................. 28 
2.3.3 Informed Consent ...................................................................................................... 28 
2.3.4 Patient Participation ................................................................................................... 28 

2.4 Framework for interpreting research findings ...................................................................... 29 
2.4.1. National Core Standards .......................................................................................... 29 

3 Chapter Three - Research methodology ...................................................................................... 32 
3.1 Introduction ............................................................................................................................... 32 
3.2 Research Strategy ....................................................................................................................... 32 
3.3 Research Design ........................................................................................................................ 32 
3.4 Research Procedure and Methods .......................................................................................... 33 



 v 

3.4.1 Research setting .......................................................................................................... 33 
3.4.2 Research target population ........................................................................................ 34 
3.4.3 Sample population ...................................................................................................... 34 
3.4.4 Research data collection instrument ........................................................................ 34 
3.4.5 Research ethical considerations ................................................................................ 35 
3.4.6 Research Data collection process ............................................................................. 36 
3.4.7 Research data processing and analysis ..................................................................... 36 

3.5 Research Reliability and Validity ............................................................................................. 37 
4 Chapter Four - Results .................................................................................................................... 38 

4.1 Introduction ............................................................................................................................... 38 
4.2. Patient Demographic Details .................................................................................................. 38 

4.2.1 Age ................................................................................................................................ 38 
4.2.2. Gender ......................................................................................................................... 39 
4.2.3 Education level ............................................................................................................ 39 
4.2.4 Employment status ..................................................................................................... 41 
4.2.5 Place of residence ....................................................................................................... 42 
4.2.6  Home language .......................................................................................................... 42 

4.3 Research question 1: What are the perceptions of patient experiences on constituents of 
the national Patient Rights Charter (confidentiality, informed consent, patient 
participation)? ....................................................................................................................... 43 
4.3.1 Patient rights ................................................................................................................ 43 
4.3.2 Confidentiality ............................................................................................................. 46 
4.3.2  Informed Consent ..................................................................................................... 49 
4.3.4 Patient Participation ................................................................................................... 52 

4.4 Research Question 2: What are the perceptions of patient experiences on Patient 
Centered Care? ...................................................................................................................... 55 
4.4.1 Perception of patient centered care specific parameters ...................................... 55 

4.5 Research Question 3: What is the relationship between the Patient Rights Charter 
(confidentiality, informed consent, patient participation) and Patient Centered Care?
 57 
4.5.1 Correlation Analysis ................................................................................................... 57 

4.6 Research Question 4: Does the Patient Rights Charter (confidentiality, informed 
consent, patient participation) have an influence on patient centered care? .............. 58 
4.6.1 Regression Analysis .................................................................................................... 58 

5 Chapter Five - Discussion .............................................................................................................. 63 
5.1 Introduction ............................................................................................................................... 63 
5.2 Demographics ............................................................................................................................ 63 
5.3 Research question 1 .................................................................................................................. 64 
What are the perceptions of patients on the national Patient Rights Charter and its 

parameters (confidentiality, informed consent, patient participation)? ....................... 64 
5.3.1 Patient rights ................................................................................................................ 64 
5.3.2 Confidentiality ............................................................................................................. 64 
5.3.3 Informed Consent ...................................................................................................... 65 
5.3.4 Patient Participation ................................................................................................... 65 

5.4 Research question 2 .................................................................................................................. 67 
What are the perceptions of patients on Patient Centered Care? ............................................ 67 

5.4.1 Patients Centered Care .............................................................................................. 67 



 vi 

5.5 Research question 3 .................................................................................................................. 67 
What is the relationship between the Patient Rights Charter (confidentiality, informed 

consent, patient participation) and Patient Centered Care? .......................................... 67 
5.6 Research question 4 .................................................................................................................. 68 
Does the Patient Rights Charter (confidentiality, informed consent, patient participation) 

have an influence patient centered care? .......................................................................... 68 
6 Chapter six – Summary, conclusions, limitations and recommendations ............................... 71 

6.1 Summary ..................................................................................................................................... 71 
6.2 Conclusion .................................................................................................................................. 71 
6.3 Limitations .................................................................................................................................. 72 
6.4 Recommendations ..................................................................................................................... 72 

References 74 
Appendix 1: Consent form ...................................................................................................................... 82 
Appendix 2:   Research Instrument ....................................................................................................... 83 
Appendix 3: Participation Information Sheet ...................................................................................... 88 
Appendix 4:  Ethics Documentation ..................................................................................................... 89 
Appendix 5:  Bio of Researcher .............................................................................................................. 90 
Appendix 6:  Permission Letter .............................................................................................................. 91 



 vii 

LIST OF TABLES 

 

Table 1: Percentage of Participant Age 38 

Table 2: Percentage of Participant Gender 39 

Table 3: Percentage Education Level of Participants 40 

Table 4: Percentage of Participant Employment Status 41 

Table 5: Percentage of Participant Place of Residence 42 

Table 6: Percentage of Participant Home Language 42 

Table 7: Awareness of patient rights 44 

Table 8: Awareness of the patient rights charter 44 

Table 9: Information Source for Patients’ Rights Charter 45 

Table 10: Participant Awareness of Confidentiality 46 

Table 11: Percentage Perception of Confidentiality Specific Parameters 48 

Table 12: Awareness of Informed Consent 49 

Table 13: Percentage Perception of Participant Informed Consent Specific Parameters51 

Table 14: Awareness of Patient Participation 53 

Table 15: Percentage Perception of Patient Participation Specific Parameters 53 

Table 16: Percentage Perception of Patient Centered Care Parameters 55 

Table 17: Correlation Analysis 57 

Table 18: ANOVA 58 

Table 19: Coefficients for MLR 59 

Table 20: Collinearity diagnosticsa 60 

Table 21: Model Summaryb 62 

 

 

 

 

 

 

 

 

 



 viii 

LIST OF FIGURES 

 

Figure 1: Participant Age Groups ............................................................................................ 38 

Figure 2: Participant Gender .................................................................................................... 39 

Figure 3: Participant Education Level ..................................................................................... 40 

Figure 4: Employment Status of Participants ........................................................................ 41 

Figure 5: Participant Place of Residence ................................................................................. 42 

Figure 6: Participant Home Language .................................................................................... 43 

Figure 7: Awareness of patient rights ...................................................................................... 44 

Figure 8: Awareness of the patient rights charter ................................................................. 45 

Figure 9: Information Source for Patients' Rights Charter .................................................. 45 

Figure 10: Participant Awareness of Confidentiality ............................................................ 46 

Figure 11: General understanding of Confidentiality ........................................................... 47 

Figure 12: Awareness of Informed Consent .......................................................................... 49 

Figure 13: General Understanding of Informed Consent ................................................... 50 

Figure 14: Awareness of Patient Participation ....................................................................... 53 

Figure 15: P-P Plot ..................................................................................................................... 60 

Figure 16: Histogram ................................................................................................................. 61 

Figure 17: Scatterplot ................................................................................................................. 61 

 

 

 

 

 

 

 

 

 

 

 

 



 ix 

ACKNOWLEDGEMENTS 

 

I would like to extend my utmost gratitude and thanks to the following people, of 

whom without this research would have not been possible:  

 

First and foremost, thank you to the study participants for dedicating their time towards 

the research, and to the hospital for granting me permission and access to collect my 

data. 

 

I would like to extend my greatest thanks to my supervisor Mr Samukelo Ngubane. 

Your support and guidance during this journey has been much appreciated.  

 

My husband Lesego Diale, I cannot begin to describe the amount of gratitude I have for 

you. You have been my pillar of strength, my constant structure of support and my 

continuous source of love and encouragement. Thank you for always seeing the best in 

me and constantly urging me to reach my full potential. 

 

My parents Boitumelo Nku and Michael Nku who begun this journey with me long 

before I even imagined reaching this point. You have endured so much to see me 

through the difficult times along this journey. Thank you for all your love, 

encouragement, patience and support. 

 

Mr Anesu Kudzwai my exceptional statistician, thank you for the statistical guidance 

throughout this journey. 

 

My precious daughter Kgatoentle Diale, this thesis my dear is dedicated to you. You put 

a smile on my face every day throughout my toughest days and made each hurdle worth 

overcoming. We journeyed through this together and for that I owe you many thanks 

for inadvertently carrying this weight with me. 

 

 

 

 

 



 x 

DEFINITION OF KEY TERMS AND CONCEPTS 

 

Acronym Full description 

PRC Patients’ Rights Charter 

PCC Patient Centered Care 

NCS National Core Standards 

HPCSA Health Professions Council of South Africa 

EFA Exploratory Factor Analysis 

KMO Kaiser-Meyer-Olkin  

ICASA Independent Communications Authority of SA 

ANOVA Analysis of variance 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



 11 

1 CHAPTER ONE – BACKGROUND AND INTRODUCTION 

 

1.1 Background  

This research seeks to assess the influence of the South African Patient Rights Charter 

(PRC) on the implementation of patient centered care (PCC) in a South African tertiary 

public healthcare facility. As the essence of patient centered care places patients at the 

centre of the health care system, healthcare organisations are increasingly focused on 

providing care which is patient-centered rather than disease-focused (Fix et al., 2018). 

As a result, public healthcare organisations are required to transform their culture of 

care and key managerial and organisational factors in a manner best suited for 

implementing patient centered care (Wolff & Jacobs, 2015). In this context, the primary 

role of the PRC is to promote and protect the rights of patients seeking proficient 

medical assistance, which must be provided economically and efficiently to provide 

citizens with the best possible value for money, in alignment with the principles of the 

PRC  (The Department of Health, n.d.). As a result, this study will explore the extent to 

which attending patients recognise aspects of the PRC to evaluate their patient centered 

experiences in and around a South African public hospital.  

 

1.1.1 The South African Healthcare Industry 

The apartheid era in South Africa has left a legacy of inequality and poverty, with the 

discriminatory customs of the period causing lingering challenges in many sectors 

including the healthcare industry (Ramoroka, 2019). South Africa continues to face 

significant disparities in several healthcare areas that challenge the healthcare industry 

and provision of PCC, which in turn bears significant weight on society and the 

economy as a whole (Ataguba et al., 2011). These disparities impinge on the social and 

economic fabric of society through increasing direct medical costs and indirect costs to 

the economy that result from inadequate rendering of healthcare services (Benatar, 

2013). Although there are multiple factors owing to healthcare disparities in South 

Africa, differing management models between the private and public healthcare services 

appears to play a significant role (Stewart & Wolvaardt, 2019), with institutions in the 

public sector generally known to suffer poor management, underfunding and 

deteriorating infrastructure, negatively impacting the rendering of patient-centered care 

(World Health Organization, 2017). As a result, a dichotomy appears to exist between 

what is stipulated in the Patient Rights Charter and the lack of effective service delivery 



 12 

in the public healthcare sector (Tzelepis et al., 2015). Reports and results of 

investigations into the public healthcare system often describe it as collapsing with these 

results showing that several public hospitals are in a state of crisis with much of the 

public health care infrastructure in poor condition and vast sections of which are non-

operational as a result of underfunding, mismanagement and neglect (Maphumulo & 

Bhengu, 2019). 

 

 1.1.2 Patient Centered Care (PCC) 

Patient centered care is a critical aspect of health services, it represents a foundational 

shift from the traditional, provider-driven, disease-focused medical approach towards 

healthcare systems that ensure patients (along with their preferences, needs, desires and 

experiences) are fully integrated into every phase of health care services, including  

consultation, treatment and follow-up (Stewart & Wolvaardt, 2019). PCC is regarded as 

the foundational determinant of healthcare management and provision (Berghout et al., 

2015). Therefore, all healthcare systems globally including South Africa, are designed to 

be centered around a proficient patient-healthcare worker relationship, in which it is 

imperative that concise attention be paid to patient interactions with healthcare 

providers (Jardien-Baboo et al., 2016). As a result, healthcare institutions are required to 

implement the necessary organisational changes required to transform from a 

traditionally provider-centric care system towards systems where patient preferences 

drive care and sustain the culture of PCC (Berghout et al., 2015). In contrast, research 

shows that patient experiences at public healthcare institutions in South Africa are often 

coupled with frustrations that occur as a direct result of the daily management 

challenges (Haskins et al., 2014). Facing staff shortages and overcrowding, healthcare 

providers often have great difficulty providing PCC which inadvertently leads to the 

negative experiences and frustrations faced by patients (Maphumulo & Bhengu, 2019). 

These experiences generally stem from poor management or implementation of the 

Patient Rights Charter (a fundamental constituent of PCC) that leaves patients with a 

lack of understanding regarding issues pivotal to PCC, such as confidentiality, informed 

consent and decision making (Effects of Poor Communication in Healthcare, n.d.). 

  

 1.1.3 The Patient Rights Charter (PRC) 

In consultation with the Health Professions Council of South Africa (HPCSA) and 

several other bodies, the South African Department of Health established the national 



 13 

Patients’ Rights Charter to ensure the right to healthcare access as per the Constitution 

(Department of Health, n.d.). In this context, the concept of patient-centered care is 

endorsed in the Constitution of South Africa Second Amendment Act, no. 3 of 2003, 

where it is stated that all citizens have the right to health care that is caring, free from 

harm and as effective as possible with value for money (South Africa et al., 2015). This 

was done in response to the violation of basic human rights experienced by healthcare 

seekers making use of public health facilities during and post-apartheid (The 

Department of Health, n.d.): “The department of health is committed to upholding, 

promoting and protecting this right and therefore proclaims the Patients’ Rights Charter 

as a common standard for achieving the realisation of this right” (The Department of 

Health, n.d., p. 1). The charter aims to promote deliverance of quality healthcare in 

South Africa’s state hospitals by empowering patients and promoting ethical practices 

and equality within the sector  (Health Professions Council Of South Africa, 2008). As a 

result, the Patients’ Rights Charter paves way to establishing and sustaining patient 

centered care as its principles seek to introduce a new approach to service delivery that 

puts people first, and encapsulates the stated values of public service in South Africa, 

which directly relate to the concept of patient-centered care (Batho Pele White Paper, 

1997). With successful implementation of the Patients’ Rights Charter the intended 

outcomes are that patient autonomy is recognized, collaboration between patients and 

their healthcare workers is enhanced, patient treatment plans are improved and patient 

complaints and litigations are reduced, thus leading to overall improvement of 

healthcare services along with the positive impact thereof for organisational functions in 

public healthcare institutions and the economy as whole (Njuguna et al., 2019).   

 

 1.2 Research Conceptualisation 

 1.2.1 Research Problem Statement 

Statista (2020) revealed that the national public healthcare sector remains the sole 

provider of health care for approximately 84% of the national population, thus it 

appears the majority of South Africans continue to receive inadequate health services 

that are largely lacking the foundation of patient centered care. Nkrumah and Abekah-

Nkrumah (2019) corroborated this concept and established that the underlying barriers 

to patient centered care typically include resource constraints, resistance to change, poor 

staff commitment and unsupported policies, which are factors that appear to be 

pertinent to the South African context. This is supported by Lloyd et al. (2018) who 



 14 

found that over and above the limited physical resources, staff shortage and poorly 

trained staff, management’s role in policy implementation is a key barrier to the 

implementation of patient centered care.   

 

Therefore, it appears healthcare management and service delivery in the public sector 

may not be executed in accordance with the principles espoused within the Patient 

Rights Charter (Tzelepis et al., 2015). As a result, the mission to transform healthcare to 

provide patient-centered care through the Patient Rights Charter, may fall short of its 

intended outcomes and instead appears to pose a heavy burden on patients and 

healthcare providers related to adverse outcomes both for the populace and overall 

economic development (Malakoane et al., 2020) .  

 

Parsapoor et al. (2014) concurs that implementation of the Patient Rights Charter 

remains a serious challenge for the healthcare system. As the ultimate goal of the Patient 

Rights Charter is to strengthen the patient centered approach in health service 

management (Cohen & Ezer, 2013), rendering health care in the face of such challenges 

thus leads to the question of the extent to which patients are receiving patient-centered 

care in public hospitals. In this instance, the role of the patient is regarded as pivotal 

with a view to assessing outcomes in gauging understanding of patient centered care 

through the Patient Rights Charter (Cohen & Ezer, 2013).  

 

1.2.2 The Research Aims and Objectives 

In light of the research problem stated above, the purpose of this study is to assess the 

extent to which the Patients’ Rights Charter has influence on patient centered care in 

patients attending a South African public hospital. The intention of the study is to assist 

public healthcare institutions in enforcing implementation of the Patients’ Rights 

Charter and policies relating to patient centered care, in an attempt to enhance the 

quality of healthcare services provided. The research will look at the perceptions that  

patients have on constituents of the Patients’ Rights Charter, namely confidentiality, 

informed consent and patient participation as well as their perceptions on the concept 

of patient cantered care.  In addition, the study will seek to explore if a relationship 

exists between the Patients’ Rights Charter constituents (confidentiality, informed 

consent, patient participation) and patient centered care and if so, do theses constituents 

of the Patients’ Rights Charter influence patient centered care in any way. 



 15 

1.2.3 The Research Questions and Hypotheses  

  1.2.3.1 Question 1: 

What are the perceptions of patient experiences on constituents of the national Patient 

Rights Charter (confidentiality, informed consent, patient participation)? 

 

H0: The perceptions of patient experiences on the PRC (confidentiality, informed 

consent, patient participation) are favourable. 

H1: The perceptions of patient experiences on the PRC (confidentiality, informed 

consent, patient participation) are less than favourable. 

  

  1.2.3.2 Question 2: 

What are the perceptions of patient experiences on Patient Centered Care? 

H0: The perceptions of patient experiences on Patient Centered Care are favourable. 

H1: The perceptions of patient experiences on Patient Centered Care are less than 

favourable. 

 

  1.2.3.3 Question 3: 

What is the relationship between the Patient Rights Charter (confidentiality, informed 

consent, patient participation) and Patient Centered Care? 

 

H0: There is no relationship between the Patients’ Rights Charter (confidentiality, 

informed consent, patient participation) and patient centered care. 

H1: There is a relationship between the Patients’ Rights Charter (confidentiality, 

informed consent, patient participation) and patient centered care. 

 

  1.2.3.4 Question 4: 

Does the Patient Rights Charter (confidentiality, informed consent, patient 

participation) have an influence on patient centered care? 

 

H0: The Patients’ Rights Charter (confidentiality, informed consent, patient 

participation) does not have a significant influence on patient centered care. 

H1: The Patients’ Rights Charter (confidentiality, informed consent, patient 

participation) has a significant influence on patient centered care. 

 



 16 

 1.3 Research Delimitations and Assumptions of the Research Study 

Due to the scope of the study, the research only included one public hospital in the 

Gauteng Province of South Africa. Thus, research results cannot be generalised across 

all public hospitals.  Further information could possibly have been obtained if a wider 

research population had been involved in the study. 

 

Patient-centered care is a complex, multifaceted and long-term endeavour which occurs 

at multiple levels of the healthcare organisation. In this regard, assessment of all the 

relevant aspects was beyond the scope of the current study due to the diverse and broad 

nature. As a result, the scope of the study only allowed for particular aspects of patient 

centered care to be assessed. The study therefore focused solely on the challenges of 

incorporating patient-centered approaches through the Patient Rights Charter in the 

context of regulations concerning best practice for healthcare services. This was done 

using the fundamentals which underlie patient centered care in healthcare services, in 

particular confidentiality, informed consent and patient participation in decision making.  

 

The study assumes participants provided truthful responses throughout. Discussed in 

more detail, the process and steps undertaken to ensure anonymity can be found in 

chapter three (methodology), serving the purpose of ensuring participant truthfulness is 

maximized. Making use of Linkert scale items to assess the perceptions that participants 

have on constituents of the PRC and PCC, the research assumed that the scale intensity 

of the attitudes was linear. 

 

1.4 Research Significance  

A consequence of poor patient centered care is the prolongation of patient disease and 

suffering, which ultimately bears long term economic and healthcare implications for 

the patient and the organisation (Dhai, 2015). Some direct and indirect implications of 

prolonged disease and dissatisfactory healthcare services have been described by World 

Health Organisation (2018) are as follows:  

- Poor health outcomes contributing to individual and community suffering and 

the spreading of communicable disease, which in turn increases the burden on 

the public healthcare institution. 

- Poor physical health leading to mental and emotional strain on patients.  



 17 

- Dissatisfaction of patients resulting in litigations against the healthcare 

institution and its employees.  

- Increased healthcare costs due to prolonged disease. 

- Poor health outcomes resulting in reduced contribution to one’s employment 

with further  implications to the economy entirely. 

- Poor health outcomes increasing access to social welfare and impacting the 

economy as a whole.  

 

It is anticipated that the results of the study may assist in further evaluating outcomes of 

the Patient Rights Charter on patient centered care. This will in turn assist the hospital 

and possibly similar healthcare institutions to determine whether implementation of the 

Patient Rights Charter is an effective policy in terms of providing patient centered care 

and improving overall healthcare service delivery. 

 

 1.5 Preface to the research report 

To this end, this research report consists of six chapters. Following this introductory 

chapter, chapter two will outline the literature review that covers the problem at hand, 

past studies relating to the research and the interpretive and conceptual frameworks. 

Chapter three will then discuss the research strategy, design, procedure & methods, 

reliability & validity measures as well as limitations. Chapter four and chapter five will 

present the research results and discussion findings respectively, while chapter six will 

deliver the summary, conclusions, and recommendations of the research.  

 



 18 

2 CHAPTER TWO - LITERATURE REVIEW 

 

This chapter explores literature relevant to the research to facilitate understanding of the 

problem and identify the knowledge gap. It explores literature from South Africa as well 

as other countries facing similar challenges and provides a theoretical framework for 

interpreting the research findings and identifying attributes that are key to the research.  

 

2.1 Problem analysis 

2.1.1 Societal Impact of Disease and Public Healthcare 

While South Africa holds just over 58 million inhabitants, only 16.4% of its population 

is covered by medical aid schemes and makes use of private healthcare (Statista, 2020; 

Stats Sa, n.d.). Bradshaw (2019) predicts that the number of people that require health 

care is projected to increase in South Africa as a result of rising life expectancies, 

expanding HIV treatment, and a rapid increase of economy impacting diseases such as 

cardiovascular disease, diabetes and tuberculosis. He further adds that this burden is set 

to result in significant economic loss through mortality, treatment costs and effects on 

productivity (Bradshaw et al., 2019).  This trend is prospectively expected to continue 

and has been compounded by the ongoing global Covid 19 pandemic, which is 

challenging healthcare service systems and organisations (Pillay et al., 2021). This shift in 

the burden of disease creates a need for people with multiple comorbidities to seek 

multiple medical consultations resulting in increasing healthcare costs across the public 

healthcare sector (Mbunge, 2020). In addition, South Africa is increasingly seeing the 

simultaneous coalescing of chronic diseases such as HIV with diabetes, which has 

resulted in an augmented burden on the healthcare system (Batho Pele White Paper, 

1997).  

 

The ongoing impact of South Africa’s burden of disease requires patients to attend 

regular clinic and hospital appointments, adhere to ongoing diagnostic and therapeutic  

tests, remain compliant on chronic medications, and maintain an overall healthy lifestyle 

that includes healthy meals, self-care and taking responsibility of one’s own health 

(Wolff & Jacobs, 2015). In order to assist patients to improve their health outcomes, 

healthcare systems are adopting patient-centered practices which aim to deliver quality 

care and value for money, while acknowledging the responsibilities that fall upon the 

patient (Adams, 2010). With the public healthcare system bearing much of this 



 19 

healthcare burden, state hospitals face challenges that render them unable to 

accommodate and provide patients with the quality of care as required by South Africa’s 

healthcare standards (Department of Health, 2011) . 

 

Maphumulo and Bhengu (2019) found that the underperformance within these facilities 

can be linked to inadequately trained staff, erratic supply of medication, frequent lack of 

stock, poor allocation of resources and a lack of essential equipment. In addition they 

state that staff shortages significantly hinder the ability of public hospitals to develop 

relationships with patients, which inevitably hampers the long term care required for the 

effective treatment of chronic diseases (Maphumulo & Bhengu, 2019). Thus, a need 

exists to improve the patient’s public healthcare experience, reduce the cost of care and 

improve the patient-provider relationship (Adams, 2010). In support of this concept, 

Richards and Wicks (2015) successfully demonstrated the effectiveness of PCC 

innovations in improving patient experiences, trust, care, quality, chronic disease 

management and outcomes. 

 

2.1.2 Patient Centered Care Defined 

Patient centered care is defined as “care that is respectful of, and responsive to 

individual patient preferences, needs and values, and ensures that patient values guide all 

clinical decisions” (Wolff & Jacobs, 2015, p. 79). It therefore broadens the conventional 

medical approach to include the patient as an active participant in care. It is built around 

the needs of the individual and is contingent upon the interpersonal relationship 

between patient and health service provider (Mapes et al., 2019).   

 

According to De Man et al. (2016) patient centered care assists patients to become 

active participants in their own healthcare, which is essential to the delivery of effective 

medical care systems. As a result, patients are also required to understand their role as 

partners in their own care and be willing to collaborate with healthcare providers to 

improve  their self-care experiences and concerns (De Man et al., 2016).  

 

To this end, as part of the movement towards patient-centered care, several countries 

have adopted charters of rights for patients, and South Africa is no exception, having 

formulated the National Patient Rights Charter to ensure the realisation of the right to 



 20 

access healthcare services as per the Constitution (Act No 108 0f 1996) of South Africa 

(South Africa et al., 2015).   

 

2.1.3 Patient Rights Charter Defined 

According to The Department of Health (n.d.) the Patient Rights Charter typically 

includes rights that already exist in law, as well as a variety of statutes that are applicable 

to the rendering of healthcare services. Three distinct sources of legal and ethical 

principles inform the Patient Rights Charter, these are the Constitution (and all statutes 

and regulations stemming from it that embody its principles), medical case law and the 

Health Professions Council of South Africa (HPCSA) (South Africa et al., 2015). The 

HPCSA is mandated to set and maintain healthcare standards, with the primary role of 

protecting the public and guiding the profession, it is guided by a formal regulatory 

framework that includes the Health Professions Act 56 of 1974 (HPCSA, n.d.)  Every 

institution which provides healthcare services is required to operate in a manner 

compliant with regulations and requirements as set out by the HPCSA (HPCSA, n.d.). 

  

The ‘Batho Pele’ principles translating to ‘people first’ are principles developed in line 

with the PRC to transform public service delivery in South Africa (Batho Pele White 

Paper, 1997). These principles align with the Constitution (Act No 108 0f 1996) of 

South Africa in that they seek to respond to people’s needs, thus all healthcare conduct 

must support and reflect its values and aims. Under the Constitution, all citizens enjoy 

certain rights, and healthcare organisations have the responsibility to ensure those rights 

are respected. In addition to these rights, patients also have responsibilities which are 

also set out in the PRC. These rights and responsibilities are presented below (The 

Department of Health, n.d.) . 

 

The patient rights as presented in the PRC include: 

A healthy and safe environment; Participation in decision-making; Access to health care 

services which includes receiving timely emergency care and being treated patient with 

dignity and respect; Knowledge of one’s health; Information and freedom to utilize 

medical insurance; Choice of healthcare services; Treated by a named healthcare 

provider; Confidentiality and privacy; Informed consent; Right to refusal of treatment; 

Right to referral for a second opinion; Continuity of care; Complain about health 

services. 



 21 

Patient responsibilities  as presented in the PRC include:  

Taking care of the records in their possession; Taking care of one’s health ; Not abusing 

the healthcare system; Providing healthcare providers with relevant and accurate 

information for diagnostic, treatment, rehabilitation or counselling purposes; Advising 

healthcare providers of their wishes in treatment and in the event of death; Complying 

with treatment; Enquiring about healthcare related costs; Caring for and protecting the 

environment; Respecting the rights of other patients and healthcare providers; Knowing 

your local healthcare services and what they provide 

 

2.1.4 Implementation of the PRC and PCC 

Implementing a patient centered model of care which embraces the rights and principles 

set forth in the PRC has profound implications for the way health services are managed, 

planned, delivered, and evaluated. Four main components are considered essential in the 

performance of PCC (Fix et al., 2018), these components are: The professional skills of 

healthcare providers (relating to the training and development of healthcare 

professionals); The care environment and whether this is conducive for PCC (relating to 

the environment being conducive for privacy and confidentiality); The person-centered 

processes (relating to effective communication pertaining issues such as obtaining 

informed consent); The expected outcome (being measured from the patients 

perspective and not particularly the therapeutic outcome as perceived by the health 

professional). 

 

At the heart of these components and their implementation are health care management 

and leadership, defined as the ability to inspire individual and organisational excellence 

in healthcare service delivery, to create a shared vision and successfully manage change 

to attain strategic health service goals and successful outcomes (National Health Act, 

2003). Healthcare management and leadership is the driving force behind decision 

making and communication and is responsible for guiding the vision of a healthcare 

organisation (National Health Act, 2003). Thus, it forms a critical aspect in any change 

initiative toward patient centered care. 

 

2.1.5 Healthcare management 

Maphumulo and Bhengu (2019) state that public hospital management is in crisis. The 

national policy on healthcare management identified the challenges that hamper the 



 22 

delivery of effective and efficient healthcare services, these stem from the lack of 

appropriate legislation and policies. While in other cases the challenges related to 

capacity constraints, such as the competency levels of hospital CEOs, lack of proper 

training, lack of strategic support, and lacking the capacity to deal with small operational 

issues (National Health Act, 2003). This national policy on management of hospitals 

was thus derived to ensure that the management of hospitals is underpinned by 

principles of effectiveness, efficiency and transparency (National Health Act 2003). The 

objectives set out in this policy specifically for management teams are as follows:  

- Promoting applicable legislations and policies to improve hospital functions 

- Ensuring the appointment of highly skilled managers 

- To move towards decentralisation of management 

- To develop frameworks that promote accountability 

- To provide the training and development of managers in leadership, 

management and governance 

 

2.1.6 Institutional theory 

As described by Greve and Argote  (2015) “ The institutional theory focuses on the 

roles of social, political and economic systems in which companies operate and gain 

legitimacy”(Greve & Argote, 2015, p. 3).  This theory within the management context 

describes how the institution provides the ‘rules of the game’ and defines the available 

ways to work by encouraging or discouraging given behavioural patterns (Debroux, 

2010). While the hospital is an entity on its own with its own structures and policies, it 

cannot operate much of its desired functions solely without the intervention of The 

Department of health. The Department of Health provides policies and regulations to 

the institution in an attempt to manage the different operational functions effectively. 

These inherited policies and guidelines were developed to serve all healthcare 

institutions, based on research of a broad nature rather than from a focus on an 

individual institution (Debroux, 2010).  This is turn bears significance with regards to 

how effective and efficient these policies will be in individualized institutions. This 

thought is further refined by Zucker (1987) who mentions that organisations are 

generally influenced by normative pressures, that occasionally arise from external 

sources such as the state, whose involvement is of a broad nature. Zucker (1987) further 

goes to state that often times these pressures can also arise from the organisation itself. 

To counter these pressures, public healthcare institutions make use of committees and 



 23 

general audits whose role is to ensure that the incorporated policies and regulations are 

being implemented efficiently and effectively (Zadeh et al., 2016).  

 

2.1.7 Implementation Theory  

A series of constructs within five structural areas interact to influence implementation, 

these include intervention characteristics, inner setting and outer setting of the 

organisation, individual characteristics, and the process to be implemented. The five 

structural areas also include pertinent factors such as strength of evidence for the 

implementation (linked to knowledge about what is being implemented), 

implementation fit within the organisation’s practices (adaptability), organisational 

readiness to implement the change (priority, climate, training), role of leadership 

(engagement, management and resource allocation) and engagement of staff (Schein, 

1992).  

 

The implementation theory provides a conceptual framework for understanding how 

healthcare leadership can typically implement PCC and PRC practices as 

‘implementation’ describes the aggregation of processes needed to get an intervention 

into use within an organisation on a daily basis (Sinclair, 2001). It is a social process 

defined by the context in which it takes place and requires engagement of all the team 

members who are involved in the process, alongside a leadership strategy to accomplish 

the intended outcome (Sinclair, 2001). In addition, implementation requires creation of 

structures within the organisation that will facilitate the process (Schein, 1992).  

 

Asumeng and Osae-Larbi (2015) describe the implementation of organisational change 

in healthcare organisations in terms of bridging (integration of different facets of the 

organisation), redesigning (integration among professionals) and engaging (directing and 

leading behaviours towards the core values and goals) the relevant tools and 

frameworks. The Department of Health (n.d.) developed the National Core Standards 

(NCS) in line with the Office of Occupational Health Standards as a tool to guide 

healthcare institutions with the implementation of different domains within the 

organisation. This NCS framework is discussed further in section 2.4 as the interpretive 

framework. 

 

 



 24 

2.1.8 Systems Theory 

The systems management theory proposes that an organisation consists of multiple 

components that work together for the greater outcome. The theory emphasizes the 

concept of collaboration of all the functions of the organisation (Chikere & Nwoka, 

2015). The key elements pertinent to the success of the organisation are Synergy, 

interdependence and the interrelations between various subsystems. Furthermore, the 

theory describes how that over and above employees, other crucial elements in the 

organisation include departments, workgroups and business units (Kessler, 2013).  

 

2.1.9 Overall Economic Impact on Healthcare Services  

In addition to facing a civil claim in negligence, healthcare service providers or 

organisations whose practice falls short of acceptable standards may face disciplinary 

action by the Health Professions Council with possible suspension of duties or revoking 

of a medical licence entirely (Department of health, n.d). The number and value of 

clinical negligence claims brought in South Africa has been rising rapidly in recent years, 

which has had drastic financial implications on the public healthcare sector (Dhai, 2015).  

 

A large number of these litigations result from dissatisfaction with services and 

interactions with public healthcare institutions (Pienaar, 2016). Raveesh et al. (2016) 

found that some of the common grounds for majority of South African medico legal 

challenges are: healthcare workers avoid showing compassion, failure to communicate 

clearly and effectively, and insufficient information provided for patient follow ups, all 

of which pertain to patient centered care (Raveesh et al., 2016).  

 

Although it is the duty of the attending healthcare worker to assure dignified efficient 

care of high quality is delivered to a patient, the institution bears the weight of 

responsibility for the overall operations and can therefore be held responsible and bear 

direct liability for failing to provide a safe environment that can provide quality 

treatment (Raveesh et al., 2016). As a consequence, these litigations come attached with 

significant cost implications for public healthcare institutions, which is transferred to the 

state thus resulting in dire economic drawbacks. Zikali (2019) estimated that the 

medico-legal claims in 2019 amounted to at least R20 billion for South African state 

hospitals. In addition, the World Health Organization (2017) mentioned that the long-

standing consequences of poor delivery of patient centered care incur additional 



 25 

healthcare expenditures for both the patient and the state.  This is over and above poor 

health outcomes whose long-term implications (and associated cost) can result in 

ongoing economic impact disease, disability and in most cases death. The report states 

that the economic costs attached to health outcomes resulting from poor quality of care, 

is said to amount to trillions of dollars yearly at an international level (World Health 

Organization, 2017).  

 

The PRC affords the opportunity for communication between patient and provider so 

any areas of concern can be clarified in advance, thus circumventing the prospect of 

litigation entirely (Pienaar, 2016). In this context what a PRC is intended to add is a 

catalyst through which to resolve individual patient concerns quickly and economically. 

It details expectations for how a patient experiences care within the present offerings of 

the health care system, known as rights “in” healthcare (Pienaar, 2016).  

 

2.2 Research knowledge gap analysis 

With the intention of adding significant value to the existing body of knowledge, this 

section focuses on existing literature to explore similar studies, methods, procedures, 

findings and conclusions in Sub Saharan Africa and similar countries in order to 

contextualise the South African scenario and the current study.  

 

A critical analysis conducted by Nevhutalu (2016) following an ethics audit at the Chris 

Hani Baragwanath Academic Hospital in South Africa, revealed no correlation exits 

between the theory and the practice of the Patient Rights Charter. The study explores 

various case reports that highlight various violations of patient rights at the Chris Hani 

Baragwanath Academic Hospital, emphasizing poor implementation of the Patient 

Rights Charter. The results of this study are especially significant as the hospital is one 

of the prominent tertiary training institutions for healthcare services in South Africa and 

is thus reasonably expected to create appropriate benchmarks for provision of services 

in line with PCC and PRC (Nevhutalu, 2016).  

 

Njuguna et al. (2019) looked at the influence of the Patients’ Rights Charter on health 

systems responsiveness in Kenya. Making use of a cross sectional descriptive study, 

qualitative data was obtained from healthcare workers using questionnaires. The study 

found that “the awareness and knowledge of the Patients’ Rights Charter was significant 



 26 

and had an influence on the responsiveness of health systems”(Njuguna et al., 2019, p. 

4663). As successful implementation of the Patients’ Rights Charter relies on both the 

patient and healthcare provider, the current study in contrast to Njuguna et al. (2019) 

focuses solely on the patient perspective.  

    

Dadashi et al. (2019); Mastaneh and Mouseli (2013); Razavi et al. (2006) all looked at 

awareness of Patient Rights Charters in various regions in Iran among patients and 

healthcare workers, and came to the conclusion that awareness and practicing of patient 

rights is limited and in need of intervention. Agrawal et al. (2017) also focusing on 

patient awareness in Egypt came to the conclusion that patient rights awareness was low 

among patients, families and healthcare workers, with much needed attention to 

educating healthcare workers on the contents and importance of the Patient Rights 

Charter. Furthermore a recommendation was made of forming a committee to monitor 

appropriate implementation of the Patient Rights Charter (Agrawal et al., 2017). 

 

These challenges are not uncommon in other African hospitals. Kagoya et al. (2013) 

focusing on patient rights practice and awareness in a national hospital in Uganda found 

that over 80% of patients and healthcare providers had never heard of a Patient Rights 

Charter, although awareness was higher amongst the healthcare providers. Zeina et al. 

(2013) looked at the manner in which patient rights are perceived and exercised in Egypt 

among patients, their companions and staff members. While three quarters of the 

patients were not familiar with existence of a Patient Rights Charter, about half of the 

healthcare workers were also unaware of it. Majority of the respondents reported having 

learnt of the charter through mass media, followed by posters displayed on the hospital 

walls (Zeina et al., 2013). 

 

A vast amount of research looking at patient rights has focused on awareness among 

patients and healthcare workers. Although this is of vital importance to the fundamental 

concept of the charter, it is equally as important to establish if the charter has effectively 

influence desired outcomes (Fix et al., 2018). Whilst it is noted that the charter 

components have positive effects on health outcomes in general, there is not much 

evidence to suggest that these outcomes are specifically of a patient centric nature (De 

Man et al., 2016). Together with all the research conducted in third world countries 

similar to South Africa, Nevhutalu (2016) added knowledge specific to South Africa on 



 27 

the importance of patient awareness of the Patient Rights Charter. As a result, it has 

become evident that the relationship and influence of the Patients’ Rights Charter on 

patient centered care is of utmost importance and thus there is room for research to 

establish this influence.  

 

2.3 Quantitative variables key to research 

Strategies for the clinical delivery of PCC include the incorporation of knowledge of the 

patient history, the conduct of consultation sessions, providing validation, prioritizing 

well-being ahead of routines and care tasks, simplifying and personalizing the 

environment and performing activities that promote well-being and comfort. 

Consequently, these strategies which are central to the concept of patient centered care 

and most representative of the patient-doctor relationship are confidentiality, informed 

consent and patient participation which form part of patient rights in the PRC and have 

been used as the key independent variables for the research.  

 

2.3.1 Patient centered care 

PCC consists of five key dimensions (Mead & Bower, 2000), these dimensions have 

been describes as follows: 

i) Patient as a person - describes the physician getting to know the patient in a 

comprehensive manner. This begins by the physician conducting a full patient history, 

making sure to listen carefully to all the aspects of the patient history (includes main 

complaint, medical and surgical history, social history), followed by appropriate 

examination and assessment in a private setting.  

ii) Bio psychosocial perspective - relates to the physician getting to know all the aspects 

pertaining to the patient, including their biological, psychological and social issues. 

iii) Sharing power and responsibility - relates to patient autonomy, requiring that the 

physician respects the patient’s autonomy and affords them the opportunity to be 

involved in the decision-making process. 

iv) Therapeutic alliance - describes the partnership formed between the physician and 

the patient that works to benefit the patient. 

v) Physician as a person - relates to active self-awareness and self-control of the 

physician as all emotion and biases displayed by the physician play a role in the recovery 

journey of the patient. 

 



 28 

2.3.2 Confidentiality  

In healthcare services confidentiality is defined as “the law whereby a doctor or medical 

practitioner cannot reveal anything said to them by their patients during consultation or 

treatment” (Dyban, 2015). It is thought to be a key feature of patient centered care and 

ethical medical practice and is understood to be guaranteed in order for patients to trust 

in the interaction with the healthcare provider (Jones, 2003). Failure to guarantee 

confidentiality can result in legal implications, inaccurate diagnosis and poor health 

outcomes (Jones, 2003). Merideth (2007) describes five legally accepted parameters that 

are recognized as an exception to a physician fulfilling the duty of confidentiality as 

follows: 

1. Confidential information may be released if given consent to do so by the patient. 

2. A physician may release confidential information if granted a court order to do so. 

3. Confidential information may be released in order to assist a patient with continuing 

their treatment. 

4. Confidential information may be released in order to comply with the law.  

5. The clinician has a duty to protect people facing danger, and when faced with such a 

situation they may release confidential information. 

 

2.3.3 Informed Consent  

Informed consent is defined as “the process in which a health care provider educates a 

patient about the risks, benefits, and alternatives of a given procedure or intervention” 

(Shah et al., 2020). In order to fully comply with the concept of informed consent, its 

legal, ethical and administrative standards are to be fulfilled (Hall et al., 2012). The 

factors described in the acquiring of informed consent are: patient comprehension,  

patients’ use of disclosed information, patient autonomy, demands on providers and 

physicians meeting of standards (Hall et al., 2012), all of which form fundamental 

components of patient centered care. 

 

2.3.4 Patient Participation  

Patient Participation is described as “the involvement of the patient in decision making 

or expressing opinions about different treatment methods, which includes sharing 

information, feelings and signs and accepting health team instructions” (Vahdat et al., 

2014). The  encouragement of participation of patients in their healthcare has been 

shown to result in better outcomes, in addition to improved voluntary active 



 29 

participation which is key to patient centered care and resulting long term health 

maintenance (Vahdat et al., 2014). The key factors that influence patient participation in 

the decision-making process are described as follows: 

- Patient related factors: demographics; personal characteristics; cultural knowledge; 

beliefs/ values; knowledge 

- Diseases related factors: symptoms; stage; illness severity; health outcomes; health 

expectations 

- Healthcare worker related factors: interpersonal communication skills; beliefs; values; 

knowledge 

- Healthcare setting factors: -cultural appropriateness; competency of the system; 

location; type of institution 

- Health provider task factors: cultural appropriateness; competence; behaviours 

 

2.4 Framework for interpreting research findings 

2.4.1. National Core Standards 

The efforts being pursued by the PRC to improve on the quality of health care services 

is proving to have many difficulties. In order to strengthen these efforts, the National 

Core Standards (NCS) were established by the Department of health. The primary 

objectives of the NCS are to develop criteria and indicators for the assessment of health 

establishments; to set a benchmark of standards for health establishments; and to 

establish a baseline for hospitals and communities to inform their development 

(Department of Health, 2011). 

 

The NCS tool is structured into seven domains. Each domain has sub-domains, within 

which are a set of standards. Each standard has a number of criteria that are achievable 

and measurable as per a provided description. The first three domains are directly 

involved with the core business of the health system of delivering health care to patients 

and relate specifically to patient rights, safety, clinical governance, clinical care, and 

clinical support services. The remaining domains form the support structures which 

ensure the system can deliver its core business, these include public health, leadership 

and corporate governance, operational management, facilities and infrastructure 

(Department of Health, 2011).  

 



 30 

The tool is intended as a quality assurance mechanism that sets the benchmark against 

which delivery of healthcare services in health care organisations can be monitored by 

the Office of Health Standards Compliance (OHSC). It describes what is mandatory for 

implementation in all health establishments in South Africa to obtain national 

accreditation and certification of compliance in terms of mandated standards. The 

standards also provide details to managers of health organisations about what the 

definition of ‘adequate’ service delivery means in practical terms. In addition, it provides 

a means of measuring performance and success of implementation. As a result, 

healthcare managers in South Africa are significantly and continuously engaged with the 

NCS (Department of Health, 2011). 

 

When a healthcare facility generates an inspection report that shows non-compliance 

(score less than 50% on an NCS rating scale), the facility leadership is issued with a non-

compliance notice attached to the inspection report, along with a quality improvement 

(QIP) template. The facility leadership is then required to implement the QIP template 

(with relevant support) to correct areas of non-compliance, followed by facility self-

assessment within a stipulated time period for rectification. A follow-up re-inspection of 

implementation and compliance is then verified by the OHSC. Should the follow up 

inspection reveal persistent noncompliance, further action for enforcement or shut 

down may occur in terms of the National Health Amendment Act 12 of 2013. The NCS 

tool acknowledges that staff are key in achieving the core business of the healthcare 

system and in this regard, internal members (health care providers) play a pivotal role in 

enforcing the standards (Department of Health, 2011).   

 

It is a requirement for all health facilities to achieve a pre-determined level of  

compliance with the NCS tool in order to permit and maintain healthcare operations. 

This is enforced and monitored via internal self-assessment audits and external audits 

conducted by a quality assurance sub-directorate of the OHSC & quality assurance 

managers at the various levels and districts (Department of Health, 2011). 

 

The internal assessments done to assess the Patient’s Rights Domain of the NCS makes 

use of multiple tools to assess the different patient rights. Reports and patient files are 

analysed, internal audits are conducted, and interviews are conducted with patients and 

healthcare workers. Pertaining to the three patient rights studied in this research, namely 



 31 

confidentiality, informed consent and patient participation, the most appropriate tool is 

that of interviews. Following the use of the mentioned tools, the organisation is then 

rated based on the results obtained. This rating consists of four categories that 

correspond with the type of intervention required in connection with the results. These 

categories are as follows: extreme (X); vital (V): essential (E); developmental (D). 

Institutional interventions are made accordingly based on the overall outcome of each 

component (Department of Health, 2011). 

 

 



 32 

3 CHAPTER THREE - RESEARCH METHODOLOGY 

 

3.1 Introduction 

This chapter identifies and describes the research methodology in terms of approach, 

design, procedure and methods. It also introduces the procedure employed to collect, 

process and analyse relevant data. Reliability and validity measures applied as well as the 

ethical considerations are also described in this chapter.  

 

3.2 Research Strategy 

Saunders et al. (2006) define the research strategy as the general plan of how the 

researcher will go about answering the research questions. The three general strategies 

one can employ when undertaking research are quantitative, qualitative, and the mixed 

approach which makes use of both quantitative and qualitative research approaches. 

 

In order to fulfil the research questions and objectives posed in chapter one, this 

investigation made use of a quantitative research approach. Creswell and Creswell 

(2018) define the quantitative research approach as follows: “Quantitative research is an 

approach for testing objective theories by examining the relationship among variables. 

These variables, in turn, can be measured, typically on instruments, so that numbered 

data can be analysed using statistical procedures” (Creswell & Creswell, 2018, p. 32). 

This approach was deemed appropriate as this research seeks to ultimately identify and 

assess if there is a significant relationship between the PRC constituents and PCC in the 

hospital setting. In this context, fully structured questionnaires including Linkert scale 

type questions and closed ended questions were appropriately used to fulfil the research 

purpose. The use of these questions in this research is described below in the research 

instrument section. Furthermore, to expand on variable relationships, this strategy 

would allow for the research to assess the influence that these PRC constituents have on 

PCC if indeed a relationship does exist between the variables. The quantitative research 

approach permitted the investigation to collect, analyse and process data from a large 

sample all while minimizing bias and improving credibility of the research.  

 

3.3 Research Design 

The research design is described as “Representing the framework for data collection and 

data analysis and comprises the following five types: experimental design, cross-sectional 



 33 

or social survey design, longitudinal design, case study design and comparative design” 

(Saunders et al., 2006, p. 160).  

A cross-sectional design was regarded as suitable for the current study as it involves 

assessing data from a specific population (patients) who are selected based on particular 

interest (patient perspectives of patient centered care and the specific constituents of the 

patients’ rights charter) at one specific point in time and in a specific setting. The cross-

sectional study design in this instance is descriptive in nature as it seeks to describe the 

characteristics of the chosen variables. The descriptive research design further allows for 

correlations between the variables to be made as well as to determine the degree of 

association between the variables (Saunders et al., 2006).  

 

The chosen research methodology permits for analysis of the patients’ perceptions of 

the patients’ rights charter from their hospital experiences, and whether this influences 

their perception of patient centered care provided within the hospital setting.  

 

3.4 Research Procedure and Methods 

3.4.1 Research setting 

As the purpose of the study was to investigate patient perceptions of the PRC and PCC 

in a South African public hospital, the Tembisa Provincial Tertiary Hospital was selected 

as a suitable locality. According to the South African Doctors Hospital (n.d) information 

page, the hospital provides healthcare services to a vast and wide catchment area. As a 

Provincial Tertiary hospital, it receives health care users from, and provides specialist 

support to other regional hospitals and thus requires the expertise of clinicians working 

as specialists. The hospital is located in the township of Tembisa within the Ekurhuleni 

municipality of Gauteng Province. The immediate communities serviced by the hospital 

are Midrand and Diepsloot (including their local township and suburb areas). It is also a 

referral hospital for approximately twenty smaller clinics and two community healthcare 

centres in the region spanning across three municipalities.  As a tertiary hospital, the 

facility is also used to provide health education at a tertiary level to train future medical 

professionals (South African Doctors Hospitals, n.d). With approximately 840 approved 

and usable beds, the hospital serves a catchment population of close to 2 million people 

according to 2011 Census (Census, 2011).  

 



 34 

 3.4.2 Research target population 
The target population for the study included the patient collective who make use of the 

medical and surgical outpatient departments of the Tembisa Provincial Tertiary 

Hospital.  The medical and surgical outpatient departments were specifically selected as 

the target population as they consist of patients who attend the hospital for treatment 

without overnight stay or undergoing critical care. As a result, medical services provided 

on an outpatient or non-hospitalized basis include those of relevance to PCC and the 

PRC, namely consultation, diagnosis, treatment and rehabilitation.  

 

3.4.3 Sample population 

The sample population for the study included two hundred patients from the medical 

and surgical outpatient departments of the Tembisa Provincial Tertiary Hospital.  The 

sample size was considered appropriate in terms of the limited scope of the study. 

Sample participants were randomly selected from the waiting area based on availability 

(i.e. attending the hospital by appointment) and were not selected on the basis of their 

clinical status (severity of disease or symptoms). Patients were enrolled in the study if 

they consented to participate and if they met the inclusion and exclusion criteria. This 

included adult male or female patients over the age of 18, who were able to read, write 

and communicate in English, Tswana or Zulu (researcher acting as translator). Due to 

concerns on consent, vulnerable patients (minors, etc) and those with psychiatric 

conditions were excluded from the study. 

 

3.4.4 Research data collection instrument 

The study made use of a structured questionnaire with discrete sections to 

accommodate the aspects under investigation, namely confidentiality, informed consent, 

patient participation and patient centered care (Appendix 2). The questions were 

designed for relevancy of the investigation, using the frameworks of PCC, PRC and 

NCS tool. The structured questionnaire was considered an ideal quantitative data tool 

for use in this cross sectional study as it made use of closed ended questions and Linkert 

scale type questions. Linkert scales are used to determine the perspectives and views 

that individuals have towards a particular element (Jamieson, 2005).  

 

A comprehensive and analytical review by Joshi et al. (2015) describes how one can 

combine the items of a Linkert scale in order to generate a composite score for different 



 35 

participants, rendering the assigned scale an interval scale, thus permitting the data to be 

statistically treated with Pearson’s correlation coefficient (r) and regression analysis 

(Joshi et al., 2015). Analysis of the Linkert scale items in this regard facilitated 

determination of patient perceptions of three specific constituents of the PRC (namely 

confidentiality, informed consent, patient participation), and establishing if a 

relationship exists between these three PRC constituents and PCC. A brief description 

of each of the applicable sections of the structured questionnaire is provided below:  

 

Section A – included demographic details of patients such as age, gender, education 

level, employment status, place of residence and home language.  

Section B – assessed patient knowledge of rights and aspects of the Patient Rights 

Charter using closed ended questions. 

Section C – investigated confidentiality via closed ended questions and a five item 

Likert scale. 

Section D – explored informed consent through closed ended questions and a seven 

item Likert scale.  

Section E – assessed patient participation by asking closed ended questions and a 

seven item Likert scale. 

Section F – evaluated patient centered care using a ten item Likert scale.  

 

3.4.5 Research ethical considerations  

Participants entered the study voluntarily and were free to withdraw at any time. 

Anonymity was maintained by omitting participant names from the questionnaire and 

final report. In addition, completed questionnaires were only accessible to the 

researcher, whilst all data derived was saved in a password protected file that could only 

be accessed by the researcher. All results and records pertaining to the study were 

securely maintained, for a mandatory period of five years. The study was clarified to 

participants both verbally and via a written participant information sheet, through which 

written informed consent was obtained prior to the completion of the questionnaire 

(Appendix 3). Ethical clearance to proceed with the study was obtained from Wits 

Business School Ethics Committee (Appendix 4), whilst permission to conduct the 

study at the Tembisa Provincial Tertiary Hospital was obtained from the Gauteng 

Department of Health (Appendix 6), in addition, staff in the medical and surgical out 



 36 

patient departments of the hospital were duly informed about the research prior to the 

data collection process.  

 

3.4.6 Research Data collection process 

The study utilised hard copy questionnaires as opposed to electronic platforms, in order 

to ensure ease of accessibility and eliminate the need for participants to own a device in 

order to participate. As the study was conducted during the global Covid 19 pandemic, 

all relevant precautions were executed to ensure health and safety during the data 

collection process. Data was collected for a period of five days from consenting patients 

over a single hospital visit whilst in the waiting area, prior to their consultation. As the 

medical and surgical department of the hospital operates by appointment only at least 

one month in advance, repeat visits (and repeat questionnaires) were not possible during 

the period of data collection.  

 

The following procedures were applicable to data collection process: 

- Patients were randomly approached in the waiting area to ascertain their interest in 

participation, their eligibility for the study, and to obtain their consent to participate.  

- After the researcher fully explained the study to the patient, an information and 

consent form was provided to them, which disclosed the details relevant to the 

study. The forms were signed by each participant acknowledging their 

understanding and consent to participate.  

- The participant then immediately completed the questionnaire while the researcher 

was available for assistance. 

- Completed questionnaires were then collected in a locked box at the end of each 

day, and the box was kept in a safe and secure location, accessible only to the 

researcher. 

 

3.4.7 Research data processing and analysis 

The data gathered from participant questionnaires was analysed using descriptive 

statistics (frequencies and percentages) via IBM SPSS Statistics®. In order to fully 

address the research aim and objectives, further statistical analyses were used to describe 

the relationship between the variables of confidentiality, informed consent, patient 

participation and patient centered care. This was performed using Pearson’s Correlation 

Analysis to determine the relationship between the variables, whilst Multiple Linear 



 37 

Regression was used to determine how the variables influence each other. Results of the 

data analysis are presented in both graphical and tabular form in chapter four to follow.  

 

3.5 Research Reliability and Validity 

Reliability and validity of the research were articulated by the fact that the questions 

posed in the participant questionnaire were specifically tailored to assess confidentiality, 

informed consent, patient centered care and patient rights in accordance with criteria 

outlined in the PRC and NCS tool. In addition, all participants were required to 

complete the same questions. The descriptions of the sample, procedure and design are 

also sufficiently comprehensive to allow for transferability to other settings in a similar 

context.  

 
 



 38 

4 CHAPTER FOUR - RESULTS 

 

4.1 Introduction 

This chapter provides the presentation of results from the data collected. Data analysis 

was performed in line with the questionnaire responses received from participants. 

Whilst two hundred and thirty (230) patients were approached for participation, 

responses were received from two hundred (200) participants in total. In the process of 

analysis, participant responses were categorized to coincide with the particular sections 

of the questionnaire (namely demographic information, patient rights, confidentiality, 

informed consent, patient participation and patient centered care). The responses were 

assessed using frequencies, percentages (rounded off where applicable) as well as 

Pearson’s Correlation and Multiple Linear Regression analytical tools.   

 

4.2. Patient Demographic Details 

4.2.1 Age 

Results obtained from the respondents regarding age are represented in Table 1 and 

Figure 1 below:  

 
Table 1: Percentage of Participant Age 

Age Frequency Percent 

< 20 9 4% 

20-35 91 45% 

36-45 50 25% 

46-55 25 13% 

> 56 25 13% 

Total 200 100% 

 
Figure 1: Participant Age Groups 

 

0

10

20

30

40

50

< 20 20-35 36-45 46-55 > 56

P
e

rc
e

n
ta

g
e

 (
%

)

Age groups



 39 

 

As shown in Table 1 and Figure 1 above, of the sampled participants: 

• The majority at forty five percent (45%, n = 91) were between 20 and 35 years. 

• Twenty five percent (25%, n= 50) were between 36 and 45 years. 

• Thirteen percent (13%, n=25) were aged between 46 and 55 years and (13%, 

n=25) over 56 years, respectively. 

• The minority at four percent (4%, n = 9) were under 20 years of age. 

 

4.2.2. Gender 

The number of males versus females comprising the participants is thirty nine percent 

(39%, n = 78) and sixty one percent (61%, n = 122) respectively. This is depicted in 

Table 2 and Figure 2 below: 

 
Table 2: Percentage of Participant Gender  

Frequency Percentage 

Male 78 39% 

Female 122 61% 

Total 200 100% 

 

 

Figure 2: Participant Gender 

 
 

4.2.3 Education level 

Results pertaining to the highest level of education attained by participants is shown in 

Table 3 and Figure 3 below: 

 

39%

61%

Gender

Male Female



 40 

Table 3: Percentage Education Level of Participants  
Frequency Percentage 

No Schooling 7 3% 

Primary School 9 5% 

High School 101 51% 

Undergraduate 56 28% 

Postgraduate 27 13% 

Total 200 100% 

 
Figure 3: Participant Education Level 

 

 
 

According to the results in the Table 4.3 and Figure 4.3 above, of the sampled 

participants who provided information about their education: 

• The highest number at fifty one percent (51%, n= 101) attained high school 

level education. 

• Twenty-eight (28%, n= 56) had undergraduate education. 

• Thirteen percent (13%, n= 27) attained postgraduate education. 

• Five percent (5%, n= 9) had primary school as the highest level of education. 

• The lowest number at three percent (3%, n=7) had no formal education. 

 

 

 

 

 

0

10

20

30

40

50

60

No Schooling Primary School High School Undergraduate Post Graduate

P
e

rc
e

n
ta

g
e

 (
%

) 

Education level

Highest education level



 41 

4.2.4 Employment status 

The employment status of participants is reflected in Table 4 and Figure 4 as follows: 

 

Table 4: Percentage of Participant Employment Status  
Frequency Percentage 

Unemployed 103 52% 
Self-Employed 28 14% 
Formal Employment 50 25% 
Casual Labourer 4 2% 
Pensioner 15 7% 
Total 200 100% 

 

 

Figure 4: Employment Status of Participants 

 
 

From Table 4 and Figure 4 above, the employment status of participants is categorised 

as follows: 

• The majority of participants at fifty two percent (52%, n=103) are unemployed. 

• Twenty-five percent (25%, n=50) have formal employment. 

• Fourteen percent (14%, n=28) are self-employed. 

• Seven percent (7%, n=15) are pensioners. 

• The least number of participants at two percent (2%, n=4), perform casual 

labour. 

 

 

0

10

20

30

40

50

60

Unemployed Self-Employed Formal
Employment

Casual Laborer Pensioner

P
e

rc
e

n
ta

g
e

 (
%

)

Employment status



 42 

4.2.5 Place of residence 

Results for place of participant residence illustrate the majority of respondents (81%, 

n=163) reside in a township, fifteen percent (15%, n=30) reside in a suburb, while the 

minority at four percent (4%, n=7), reside in a rural area as seen in Table 5 and Figure 5 

below: 

 

Table 5: Percentage of Participant Place of Residence 
  

Frequency Percentage 
Township 163 81% 
Suburb 30 15% 
Rural 7 4% 
Total 200 100% 

 
Figure 5: Participant Place of Residence 

 
 

4.2.6  Home language 

Results reflect the participants’ home language as shown in Table 6 and Figure 6 as 

follows: 

 

Table 6: Percentage of Participant Home Language  
Frequency Percentage 

Afrikaans 6 3% 

English 16 8% 

Nguni (Zulu, Xhosa, Swati, Ndebele) 64 32% 

Sotho (Sepedi, Sesotho, Setswana) 86 43% 

Tsonga 19 9% 

Venda 6 3% 

Other, please specify 3 2% 

Total 200 100% 

0

20

40

60

80

100

Township Suburb Rural

P
e

rc
e

n
ta

g
e

 (
%

)



 43 

 

Figure 6: Participant Home Language 

 
*Nguni: Zulu/ Xhosa/ Swati/ Ndebele 

**Sotho: Sepedi/ Sesotho/ Setswana 

 

As reflected in Table 6 and Figure 6 above: 

• Sotho is the home language for most of the participants (43%, n=86). 

• This is followed closely by thirty-two percent (32%, n=64) of participants with 

Nguni as the home language. 

• Nine percent (9%, n=19) have their home language as Tsonga, followed by eight 

percent (8%, n=16) whose native language is English. 

• Both Afrikaans and Venda are spoken by three percent (3%, n=6) of 

participants, respectively. 

• The least number of participants (2%, n=3) have other native languages which 

did not form part of the options on the questionnaire.  

 

4.3 Research question 1: What are the perceptions of patient experiences on 

constituents of the national Patient Rights Charter (confidentiality, informed 

consent, patient participation)? 

4.3.1 Patient rights 

4.3.1.1. Awareness of patient rights 

Results illustrate that the majority of patients at eighty six percent (86%, n=172) were 

aware they have rights whilst, the minority at fourteen percent (14%, n=28) were not 

aware of this. These results are depicted in Table 7. and Figure 7 below: 

 

 
 

0

10

20

30

40

50

Afrikaans English *Nguni **Sotho Tsonga Venda Other

P
e

rc
e

n
ta

g
e

 (
%

)

Language

Home Language



 44 

Table 7: Awareness of patient rights 
 Frequency Percentage 

No 28 14% 

Yes 172 86% 

Total 200 100% 

 

Figure 7: Awareness of patient rights 

 
 

4.3.1.2 Awareness of the patient rights charter 

In accordance with the results pertaining to participant awareness of the Patient Rights 

Charter, the majority of patients at sixty nine percent (69%, n=138) indicated they were 

not aware of the PRC whilst, the minority at thirty one percent (31%, n=62) were aware 

of existence of the charter, as reflected in Table 8 and Figure 8 below: 

 

Table 8: Awareness of the patient rights charter  
Frequency Percentage 

No 138 69% 

Yes 62 31% 

Total 200 100.0 

 
 
 
 
 
 
 
 

14%

86%

Are you aware that you have rights as a patient?

No Yes



 45 

 
Figure 8: Awareness of the patient rights charter 

 

 
 

The sixty nine percent (69%) of participants who indicated they were aware of the PRC 

were further asked where they had heard about the charter. The results indicating how 

participants became informed of the charter are reflected in Table 9 and Figure 9 below: 

 
Table 9: Information Source for Patients’ Rights Charter  

Frequency Percentage 

Clinic 7 21% 

Hospital 11 33% 

online 6 19% 

television 4 12% 

word of mouth 2 6% 

other 3 9% 

Total 33 100% 

 
 

Figure 9: Information Source for Patients' Rights Charter 

 

69%

31%

Are you aware of the existence of the National 
patients' rights charter?

No Yes

0
10
20
30
40

Clinic Hospital online television word of mouth otherP
e

rc
e

n
ta

g
e

 (
%

)

Source

Where did you hear about the Patients' rights 
charter?



 46 

As shown in Table 9 and Figure 9 above, the 69% of participants who knew about the 

PRC, indicated they heard about it from the following sources: 
 

• Thirty three percent (33%, n=11), forming majority of responses, heard about 

the PRC from the hospital. 

• Twenty one percent (21%, n= 7), said they found information about the PRC 

from the clinic, whilst nineteen percent (19%, n= 6) were informed online. 

• Six percent (6%, n=2), of participants heard of the PRC from sources such as 

television and by word of mouth respectively while nine percent (9%, n=3) 

stated other miscellaneous sources. 

 

4.3.2 Confidentiality 

4.3.3.1 Awareness of confidentiality 

Results illustrate that the majority of patients at seventy nine percent (79%, n= 156) 

were aware they had the right to confidentiality, whilst eighteen percent (18%, n= 37) 

seemed unsure and the minority at three percent (3%, n = 7) were not aware of this 

patient right. These results are shown in Table 10 and Figure 10 below: 

 

Table 10: Participant Awareness of Confidentiality 
 

 

 

Figure 10: Participant Awareness of Confidentiality 

 
 

0 10 20 30 40 50 60 70 80 90

No

Yes

I don`t know

Percentage (%)

I have the right to confidentiality

 
Frequency Percentage 

No 7 3% 

Yes 156 79% 

I don`t know 37 18% 

Total 200 100% 



 47 

4.3.3.2   General understanding of confidentiality 

The seventy nine percent (79%, n=156) of participants who indicated they were aware 

of confidentiality as a patient right, were further required to indicate how they would 

best describe and define their right to confidentiality. The descriptions of confidentiality 

were divided into four categories using the definition of confidentially as stated in the 

PRC, “Information concerning one’s health, including information concerning 

treatment may only be disclosed with informed consent, except when required in terms 

of any law or an order of the court” (The Department of Health, n.d.). The four 

categories were as follows: 

- None (no understanding): where all the pertinent parameters of confidentiality were 

omitted. 

- Poor understanding: where most of the pertinent parameters of confidentiality were 

omitted. 

- Average understanding: where some parameters of confidentiality were included. 

- Good understanding: where all the parameters of confidentiality were included. 

The results pertaining to the above categories are reflected in Figure 11 below: 

 
 

Figure 11: General understanding of Confidentiality 

 
 

As shown in Figure 11 above, the 79% of participants who affirmed their right to 

confidentiality, were found to have a level of understanding as follows: 

• In accordance with the definition stated in the PRC, most participants at seventy 

percent (70%), displayed a poor understanding of the parameters of this right. 

15%

70%

15% 0%

Level of understanding of confidentiality

None Poor Average good



 48 

• Fifteen percent (15%) demonstrated average correlation with the definition of 

confidentiality, with understanding of some of the parameters. 

• Fifteen percent (15 %) displayed a poor understanding of its parameters overall. 

• There were no participants (0%) who had a good understanding of 

confidentiality and all the parameters that pertain to it. 

 

4.3.3.3. Patient perception of confidentiality specific parameters 

The participant perceptions were assessed in relation to specific parameters of 

confidentiality, where they were required to indicate to what extent they agree or 

disagree with predetermined statements describing these parameters. For ease of 

interpretation, responses which reflect ‘agree’ and ‘strongly agree’ have been aggregated, 

the same applies to responses reflecting ‘disagree’ and ‘strongly disagree.’ Results are 

portrayed in Table 11 below: 

 

Table 11: Percentage Perception of Confidentiality Specific Parameters 
 Disagree/ 

Strongly 
disagree 

Unsure Agree/ 
Strongly 

agree 

Mean Standard 
deviation 

C1 The hospital makes sure my information 
is kept in a safe and secure place 

Count 14 36 149  
4.02  

 
0.992  Row N % 7% 18,10% 74,90% 

C2 The hospital makes sure my information 
is not seen by other people 

Count 18 44 136  
3.90 

 
1.064 Row N % 9,10% 22,20% 68,60% 

C3 The doctor makes sure our conversations 
are only between the two of us 

Count 21 25 151  
4.00 

 
1.055 Row N % 10,70% 12,70% 76,70% 

C4 In some instances, the doctor can share 
my information if necessary 

Count 66 33 98  
3.14 

 
1.374 Row N % 33,50% 16,80% 49,80% 

C5 In some instances, the hospital can release 
my information if necessary 

Count 91 36 70  
2.79 

 
1.326 Row N % 46,20% 18,30% 35,60% 

 Overall     3.9715 0.90873 

 

As shown in Table 11 above, the participant perceptions of confidentiality specific 

parameters are described as follows: 

• C1: The majority of participants (75%, n=149) felt the hospital ensures 

information is kept safe and secure, whilst eighteen percent (18%, n=36) were 

unsure and the least number at seven percent (7%, n=14) did not agree. 

• C2: Most participants (69%, n=136) agreed that the hospital ensures their 

information is not seen by others. Twenty two percent (22%, n=44) were unsure 

of this aspect while the minority (9%, n=18) disagreed. 



 49 

• C3: The least number of participants (n=21) at eleven percent (11%) disagreed 

that the doctor ensures conversations remain between doctor and patient only, 

thirteen percent were unsure of this whilst the majority of participants at seventy 

seven percent (77%, n=151) felt assured of this aspect. 

• C4: Almost half the number of patients (50%, n=98) agreed that the doctor 

could share their information if necessary, while thirty four percent (34%, n=66) 

did not agree. Seventeen percent (17%, n=33) were unsure of this. 

• C5: Less than half the number of patients (46%, n=91) felt the hospital could 

not release their information if necessary, eighteen percent (18%, n=36) were 

unsure of this and more than half (36%, n=70) agreed this was acceptable.  

 

4.3.2  Informed Consent 

4.3.2.1 Awareness of informed consent 

In accordance with the results, most patients at fifty six percent (56%, n= 111) were 

aware they had the right to informed consent, whilst thirty five percent (35%, n=71) 

were unsure and the minority at nine percent (9%, n=18) were not aware of this right. 

These results are shown in Table 12 and Figure 12 below: 

 

Table 12: Awareness of Informed Consent 
 

 

 

 

 

 

Figure 12: Awareness of Informed Consent 

 
 

 

9

55,5

35,5

0 10 20 30 40 50 60

No

Yes

I don`t know

Percentage (%)

I have the right to informed consent

 
Frequency Percentage 

No 18 9% 

Yes 111 56% 

I don`t know 71 35% 

Total 200 100% 



 50 

4.3.2.2 General understanding of informed consent 

The fifty six percent (56%, n=111) participants who indicated they were aware of 

informed consent as a patient right, were requested to indicate how they would best 

describe and define their right to informed consent. The descriptions of informed 

consent were divided into four categories using the definition of informed consent as 

stipulated in the Patients’ Rights Charter “Everyone has the right to be given full and 

accurate information about the nature of ones illnesses