Institutional Disrespect and Abuse during Health-Care Utilization in Public Health Facilities of Tamil Nadu: A Facility-Based Cross-Sectional Survey

ABSTRACT

Background: Disrespect and abuse have a negative impact on the quality of care provided in the public health facilities, thereby impacting the public health‑care utilization of the patients. Objectives: This study aims to capture the burden and determinants of disrespect and abuse faced by the patients who seek care from public health facilities in Tamil Nadu. Methods: This study was conducted among 4917 participants at outpatient and inpatient levels in 18 public health facilities across six districts in Tamil Nadu. Institutional disrespect and abuse were reported as proportion with 95% confidence interval (CI). Logistic regression model was done to assess the determinants of institutional disrespect and abuse. Results: Overall, the proportion of participants facing some form of institutional disrespect and abuse was 9.8% (95% CI 9.0%–10.6%). Elderly patients (≥60 years) (adjusted odds ratio [aOR] = 2.71; 95% CI 1.27–5.76), widowed/separated/divorced (aOR = 1.99; 95% CI 1.11–3.57), patients with higher educational qualification (aOR = 1.82; 95% CI 1.25–2.64), patients belonging to the richest quintile in terms of socioeconomic status(aOR = 4.96; 95% CI 3.59–6.84), and patients having some form of chronic disease (aOR = 1.37; 95% CI 1.07–1.75) had significantly higher odds of facing institutional disrespect and abuse. Conclusion: Almost one in ten patients visiting secondary and tertiary care public health facilities in Tamil Nadu had faced some form of disrespect during their hospital visit/stay. The findings from our study should be taken up and further qualitative exploration to identify the reasons for such disrespectful care and corrective solutions should be suggested.