Micro Level Impact of the Right to Health - a qualitative Study of Patients Perceptions

Background: Health is unequally distributed across the Swedish population, even though it has ratified Human rights declarations pointing out The Right to the Highest Attainable Standard of Health for all. The meaning of these declarations is condensed in The Right to Health-concept and specified in the so called AAAQ-framework, which highlights equal Accessibility, Acceptability, Availability and scientific Quality of care as indicators for analyzing a state’s fulfillment of such declarations. Methods and findings: The aim of this qualitative interview study was to examine whether patient perspectives on health care encounters would shed new light on the focal points specified in the AAAQ-framework, i.e., complement macro analyses on a state’s fulfilment of human rights declarations. Interviews were carried out with 55 patients in a socioeconomically challenged suburb, and analyzed in accordance with established standards for thematic content analysis. Two main themes with six subthemes were identified in this descriptive phase. The patient narratives centered on health care prerequisites for good care, but patients’ own responsibility was also brought up. Most noticeable was the importance given to staff’s ability to respectfully acknowledge the meaning of individual patient characteristics, and the negative effects on patients’ wellbeing of its opposite (authoritarian and impersonal staff attitudes). The results from the descriptive phase were then deductively interpreted in relation to the AAAQ-framework. The interpretative analyses revealed that human rights inspired policies are not enough for the realization of The Right to Health as patients’ experiences of different hospitals varied significantly, despite identical policies. In addition, it underlined the importance of all four AAAQ-indicators, i.e. that scientifically appropriate care (Availability and Quality) is vital, yet that the meaning of The Right to Health-concept is not realized unless a health care experience includes emphatic encounters adapted to the individual patient’s capacities and disease experience (Accessibility and Acceptability). Conclusion: The analysis of patient perspectives on health care experiences highlighted the significance of respectful and personalized treatment. In addition to providing functioning health care facilities, a vital part of health care quality work is securing empowering care encounters. Even though human rights inspired state regulations and health