Dimensions of Dignity in State-Provided Healthcare: A Qualitative Study of Patient Narratives
Keywords:
Patient dignity, qualitative research, public healthcare, healthcare communication, autonomy, emotional safety, Iran, phenomenologyAbstract
This study aimed to explore how patients receiving care in state-provided healthcare settings in Tehran experience and define the concept of dignity during medical encounters. Using a qualitative phenomenological design, this study collected data through semi-structured interviews with 29 participants who had received care in public healthcare facilities in Tehran within the past six months. Participants were selected using purposive sampling to ensure diversity in gender, age, educational background, and treatment type. Interviews were conducted in Persian, audio-recorded, transcribed verbatim, and analyzed using thematic analysis supported by NVivo software. The data collection process continued until theoretical saturation was reached. The analysis followed a multi-stage coding process including open, axial, and selective coding to identify core themes related to patients' dignity experiences. Analysis revealed four major themes: (1) Respectful Communication—including active listening, clarity, and nonverbal cues; (2) Autonomy and Decision-Making—comprising informed consent, shared decision-making, and privacy; (3) Institutional Practices—encompassing physical environment, waiting time, bureaucracy, and treatment equality; and (4) Emotional and Psychological Safety—relating to empathy, emotional support, and minimization of shame. Participants described dignity as a multidimensional experience shaped by both interpersonal interactions and systemic healthcare conditions. Breaches in dignity were often linked to communication failures, lack of choice, and structural inefficiencies. Dignity in public healthcare is deeply relational and context-dependent, influenced by provider behavior and institutional structures. Ensuring respectful communication, supporting patient autonomy, improving institutional processes, and fostering emotional safety are critical to delivering dignity-preserving care in state-provided systems. These findings offer actionable insights for policymakers, healthcare professionals, and administrators aiming to enhance the quality and humanity of public health services.
Downloads
References
Abbaszadeh, A., Ehsani, S. R., & Heravi-Karimooi, M. (2014). Patients’ perception of dignity in Iranian healthcare settings: A qualitative study. International Journal of Nursing Practice, 20(5), 573–580. https://doi.org/10.1111/ijn.12214
Beach, M. C., Sugarman, J., Johnson, R. L., Arbelaez, J. J., Duggan, P. S., & Cooper, L. A. (2006). Do patients treated with dignity report higher satisfaction, adherence, and receipt of preventive care? Annals of Family Medicine, 4(4), 331–338. https://doi.org/10.1370/afm.448
Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? (Or it takes at least two to tango). Social Science & Medicine, 44(5), 681–692. https://doi.org/10.1016/S0277-9536(96)00221-3
Chochinov, H. M. (2006). Dignity and the essence of medicine: The A, B, C, and D of dignity-conserving care. BMJ, 332(7532), 184–187. https://doi.org/10.1136/bmj.332.7532.184
Chochinov, H. M., Hack, T., McClement, S., Kristjanson, L., & Harlos, M. (2002). Dignity in the terminally ill: A developing empirical model. Social Science & Medicine, 54(3), 433–443. https://doi.org/10.1016/S0277-9536(01)00084-3
Epstein, R. M., & Street, R. L. (2011). Patient-centered communication in cancer care: Promoting healing and reducing suffering. National Cancer Institute.
Fenton, E., & Hughes, D. (2009). Sociological perspectives on dignity. In D. K. Martin, G. T. Singer, & P. E. Singer (Eds.), Bioethics in Canada (pp. 173–180). Oxford University Press.
Gallagher, A., Li, S., Wainwright, P., Jones, I. R., & Lee, D. (2008). Dignity in the care of older people – A review of the theoretical and empirical literature. BMC Nursing, 7(11), 1–12. https://doi.org/10.1186/1472-6955-7-11
Jacobson, N. (2009). Dignity and health: A review. Social Science & Medicine, 64(2), 292–302. https://doi.org/10.1016/j.socscimed.2006.08.039
Khosravi, S., Rezai-Rad, M., & Tofighi, S. (2018). Evaluating the process of informed consent in Iran’s public hospitals: A patient perspective. Journal of Medical Ethics and History of Medicine, 11(2), 12–19.
Leino-Kilpi, H., Välimäki, M., Dassen, T., Gasull, M., Lemonidou, C., Scott, A., & Arndt, M. (2001). Perceptions of autonomy, privacy and informed consent in the care of elderly people in five European countries: The role of education. Nursing Ethics, 8(2), 97–113. https://doi.org/10.1177/096973300100800202
Lin, Y. P., Watson, R., & Tsai, Y. F. (2011). Dignity in care in the nursing home context: A qualitative study. International Journal of Nursing Studies, 48(10), 1280–1286. https://doi.org/10.1016/j.ijnurstu.2011.03.008
Matiti, M., & Baillie, L. (2011). Dignity in healthcare: A practical approach for nurses and midwives. Radcliffe Publishing.
Nordenfelt, L. (2004). The varieties of dignity. Health Care Analysis, 12(2), 69–81. https://doi.org/10.1023/B:HCAN.0000039018.40968.4e
Oosterveld-Vlug, M. G., Pasman, H. R., van Gennip, I. E., Willems, D. L., & Onwuteaka-Philipsen, B. D. (2013). Dignity and the factors that influence it according to nursing home residents: A qualitative interview study. Journal of Advanced Nursing, 69(1), 216–226. https://doi.org/10.1111/j.1365-2648.2012.06094.x
Shirazi, Z., Zeinali, M., & Hashemi, N. (2017). Patients’ perspectives on the respect for human dignity in Iranian hospitals: A qualitative study. Iranian Journal of Nursing and Midwifery Research, 22(4), 287–292.
Sulmasy, D. P. (2007). Human dignity and human worth. New Theology Review, 20(2), 18–26.
Tavakoli, N., Khosravizadeh, O., Mohammadi, E., & Sadeghi, A. (2019). Systemic barriers to patient-centered care in Iran: A qualitative study. BMC Health Services Research, 19(1), 1–10. https://doi.org/10.1186/s12913-019-4672-9
Vahidi, R., Yazdani, S., & Farahbakhsh, M. (2016). Patients' complaints in public hospitals in Iran: A qualitative content analysis. Health Promotion Perspectives, 6(4), 179–185. https://doi.org/10.15171/hpp.2016.29
WHO. (2015). People-centred and integrated health services: An overview of the evidence. World Health Organization.
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
