Literacy-Related Factors and Knowledge of Patient Rights Charter: Evidence from Nurses in Selected Hospitals in Ghana

Abstract Background Over the last few decades, most member countries of the United Nations have developed and implemented patient rights policies to protect and improve the provider-patient relationship, as guaranteed by Article 25 of the Universal Declaration of Human Rights (1948–1998). The Ghana Health Service developed the Patient Charter in 2002 to improve service quality and protect patients' rights. However, it is not yet known whether those at the frontline of healthcare delivery and patients can read and understand the contents of the charter. While studies have explored the socioeconomic and institutional level factors related to awareness and knowledge of the Patient Rights Charter of Ghana, there is a lack of literature on its readability and comprehensibility among patients and nurses. This study assesses nurses’ knowledge of the Patient Rights Charter of Ghana and associated literacy-related factors. Method An exploratory cross-sectional design and quantitative methods were used to collect data on knowledge, comprehension, and readability of the Patient Rights Charter. Two hundred and five (205) nurses from four district hospitals in the Central Region of Ghana were recruited using proportional and total enumeration sampling. Data were collected using structured questionnaires and were processed using SPSS (version 26) and an online text readability consensus calculator (version 2.0). Descriptive and inferential statistical analyses were performed, and data were presented using simple frequencies, readability statistics, and regression output. Results The results show the charter is written at a higher reading grade level; Flesch-Kincaid Grade Level (13.36), Simple Measure of Gobbledygook (11.57), Coleman-Liau Readability Index (14.2). The average reading grade level score was 14. The Gunning Fox Index (15.40) and the Flesch Reading Ease Score (34%) show the patient charter is difficult to read and will require at least 14 years of education to be able to read. Eighty-seven percent (87.3%) of nurses were able to read and comprehend the charter. Very few (8.3%) read at frustration level. Nurses' actual comprehension of the charter was the only significant predictor of knowledge of the charter. Conclusion Comprehension of the Patient Rights Charter is an important predictor of its knowledge. The results emphasize the need to enhance the readability and comprehensibility of the patient charter for providers. Hospitals can stimulate nurses’ knowledge of the charter by simplifying the charter’s language and deliberately educating nurses on its content.