Perceptions and experiences of medical confidentiality and privacy among healthcare workers and patients in Armenia: a qualitative research

Abstract

Confidentiality and privacy are essential parts of healthcare system. According to the available literature, the concepts are valued by healthcare professionals and patients. It is also shown that perception of confidentiality affects patient behavior to seek care and utilize available healthcare resources. Maintenance of confidentiality is not only ethical but also a legal obligation, and there are available laws in a lot of countries to protect confidentiality of medical information. Yet, the laws are also available in Armenia, there are no studies to explore publics or healthcare professionals’ perceptions and attitudes towards these concepts. Thus, the qualitative study was conducted with the aim to explore patients’ and physicians’ perspectives of medical confidentiality and privacy in Armenia. The participants were recruited using purposive convenience sampling method, and the data was collected through in-depth interviews (IDIs) using self-developed semi-structured interview guides. The interview guides were developed based on the available literature and cultural context. The process was guided by the framework of responsiveness and confidentiality suggested by the World Health Organization (WHO). Six physicians and eleven patients were interviewed during the study. The data was analyzed using inductive and deductive approaches. The study findings have shown that confidentiality is valued and perceived as an important component of the healthcare system; however, a gap in knowledge of the concepts and laws was also identified. The study also identified a gap in medical education regarding confidentiality practices. According to the study findings, there are differences between current practices and expectations about access to healthcare information among participants. On the other hand, the importance of confidentiality was intensively stressed for sensitive and stigmatizing diseases. In contrast, the ideas about the importance of physical privacy were superficial, and it was not emphasized during the interviews. The study also found a conservative approach and willingness to control the data available in electronic systems among patients, whereas physicians expressed that it is essential to access it fully. The unique finding of the study is participants' approach towards hiding the diagnosis from the patients, where the importance of patients’ emotional status and readiness to listen to the diagnosis was highlighted by the majority of participants. This was the first study exploring the topic in Armenia. The study findings have shown that there is a need to update the curriculum in medical universities. Also, it is important to create appropriate guidelines to make it easier for physicians to grasp the details of confidentiality and privacy concepts and laws. Simultaneously, there is a need to make patients aware of laws and their rights and provide appropriate information regarding confidentiality. The study provides evidence-based information about confidentiality and privacy for all the stakeholders, including policy-makers, healthcare professionals, and researchers.