The study was conducted in general hospitals in Addis Ababa, Ethiopia, from May 26 to July 26, 2023. The city has a total of 52 hospitals, including three nongovernmental organizations (NGOs), three owned by the defense forces and the police, and 35 private hospitals. According to the Central Statistical Agency of Ethiopia (CSA) population forecast for 2022, Addis Ababa has a total population of 3,859,999, with 1,882,000 males.

A facility-based cross-sectional study design was conducted.

All admitted inpatients in public and private general hospitals in Addis Ababa during the study period were included in the study.

Randomly selected admitted inpatients from the chosen general hospitals between May 26 and July 26 were included in the study.

Patients over 18 years of age, admitted to selected public and private hospital wards for 24 h or more, and mentally capable of providing informed responses, were included in the study.

In this study, unconscious patients, those with impaired cognitive or communication abilities, and ICU patients were excluded from the analysis.

The sample size was determined using the double population proportion formula, with the following statistical assumptions: a 95% confidence interval (CI) and a proportion of person-centered care (PCC) practice in public hospitals (P1 = 60.9%) based on a study conducted in Wollo (8), and the proportion of PCC practice at private hospitals (P2 = 70.2%) from the study conducted in Addis Ababa (7) [Alpha (α) type 1 error; β is a type 2 error; power = 80%; confidence level = 1.96. Where Zα/2 is the critical value of the normal distribution at α/2 (for a 95% confidence level, for example, α is 0.05 and the critical value is 1.96) and Zβ is the critical value of the normal distribution at β (for example, β is 0.2 for 80% power) and the critical value is 0.84), and p1 and p2 are the expected sampling proportions of the two groups.n=(Zα2+Zβ)2*(p1(1−p1)+p2(1−p2))(p1−p2)2=406

After accounting for a 5% nonresponse rate, the final sample size was set at 852, with 426 patients from private hospitals and 426 from public hospitals. Out of 27 general hospitals in the city (5 public and 22 private), two public hospitals (Ras-Desta Hospital and Yekatit 12 Hospital Medical College) and seven private hospitals (Betel General Hospital (BGH), Amen General Hospital (AGH), Tezena General Hospital (TGH), Grum General Hospital (GGH), Betezata General Hospital (BZGH), Teklehymtnot General Hospital (TMGH), and Ethio-Tebib General Hospital (ETGH)) were selected (30% of each group) using a lottery method. The sample size was proportionally allocated based on the monthly average of hospitalized patients at each hospital, and systematic random sampling was employed to identify study participants (Figure 1).

In this study, the dependent variable was person-centered healthcare practices. The independent variables included sociodemographic factors (age, gender, educational status, marital status, income, and insurance status), organizational characteristics (hospital type, welcoming environment, ease of service access, noise levels, aesthetic appeal, privacy, and information on care plans, safety alerts, and diet), and healthcare provider factors (perceived intimacy, physician competency, and self-assessed clinical knowledge).

A climate of safety is indicated by accessible and competent staff who respond quickly and a clean and well-organized physical environment (10).

Everyday climate refers to experiences of a deinstitutionalized environment that contains aspects of familiarity and everydayness and being home-like (10).

Hospitality refers to the reception and friendliness of local people, who both make you feel welcome and receive the best treatment and care (8).

Welcoming space to patient and family, Sound and noise, Ease to access services within the institution, Beauty and external appearance, Privacy to access care, Communication on the plan of care, Medication, Diet and Safety, Perceived intimacy with the provider, for the above factors Patients were classified as having a “good” perception if they responded very good and good and a “poor” perception if they responded either neutrally, poorly or very poorly (11).

Person-centered care practices: were measured with a 17-item structured questionnaire with responses structured on a five-point scale. Respondents were categorized as experiencing “good” person-centered care practices (PCC) if they scored above or equal to the mean score of 3.46, while those who scored below the mean were categorized as experiencing “poor” PCC.

Descriptive statistics such as frequencies and percentages were used for qualitative variables. The internal consistency of the PCQ-P was calculated using Cronbach's α coefficient. Bivariate and multiple binary logistic regression analyses were used to determine the associations between independent and dependent variables. The crude odds ratio (COR) and adjusted odds ratio (AOR) were calculated. To determine the factors significantly associated with the PCC, the odds ratio (OR) at the 95% CI was determined using multivariable logistic regression analysis. The Hosmer and Lemeshow tests were used to test the goodness of fit. Multicollinearity was determined using a VIF cutoff point >10. An adjusted odds ratio with a p-value < 0.05 was used to report the significant factors associated with PCC. All analyses were performed using the Statistical Package for Social Science (SPSS version 25).

This study included 848 participants from public and private hospitals, with a response rate of 99.5%. Most participants were female (58%) in private hospitals and male (54.1%) in public hospitals. The average age was 44.6 ± 14.3 years for private hospital patients and 47 ± 13.8 years for public hospital patients. Regarding marital status, 52% of participants in private hospitals and 70.8% in public hospitals were married. Monthly incomes ranged from none to 27,000 ETB (Table 1).

A majority of participants from private hospitals (71.4%) and public hospitals (63.8%) perceived the hospital environment as friendly. Accessibility of services was reported as easy by only 34.8% of participants from public hospitals, compared to 76.1% from private hospitals. Most clients from both public (79.7%) and private hospitals (71.3%) reported that there was no disruptive noise on the hospital premises.

Most participants from private hospitals, 302 (71.4%) felt that the hospital had a welcoming environment, compared to 271 (63.8%) of those from public hospitals. Additionally, 322 (76.1%) participants from private hospitals reported easy access to services, while only 34.8% of public hospital participants felt the same.

Of the respondents, 295 (69.4%) from public hospitals and 332 (78.3%) from private hospitals felt the facilities were well-maintained. Privacy was considered adequate by 74.7% of private hospital patients and 46.4% of public hospital patients. Most participants shared their views on care quality, with 352 (83.2%) from private hospitals and 332 (78.3%) from public hospitals providing feedback. Additionally, 331 private hospital patients (78.3%) and 259 public hospital patients (60.9%) felt they received sufficient information about safety alerts (Table 2).

Approximately 61.4% of public hospital clients and 80% of private hospital clients were aware of their healthcare providers. Knowledge of their condition was reported by 284 (66.8%) public hospital participants and 348 (82.3%) private hospital participants. Three-foruth (75.4%) of private hospital participants and 71.1% of public hospital participants were aware of the available treatment options. Most participants felt well-informed about their illness, with 406 (96%) in private hospitals and 393 (92.5%) in public hospitals showing strong knowledge of their condition (Table 3).

The magnitude of good person-centered care (PCC) in public general hospitals in Addis Ababa was 34.8% (95% CI: 30.3%–39.3%), compared to 70.9% (95% CI: 66.6%–75.2%) in private hospitals. Overall, 52.8% (95% CI: 49.6%–56.1%) of respondents rated the PCC practice as good (Figure 2).

Multivariable logistic regression analysis revealed that hospital attractiveness, ease of access to services, and privacy during care were significantly associated with person-centered care (PCC) practices in private hospitals. Patients who perceived the hospital as unattractive were three times more likely to rate its PCC as poor (AOR: 3.4; 95% CI: 1.70–6.77). Those who found accessing services difficult were 13.12 times more likely to consider PCC poor (AOR: 13.12; 95% CI: 6.70–25.72) compared to those who found access easy. Additionally, patients who perceived poor privacy during care were approximately eleven times more likely to rate PCC as poor (AOR: 11.01; 95% CI: 5.70–21.27) than their counterparts (Table 4).

Similarly, in the multivariable binary logistic regression analysis for public hospitals, perceived intimacy with the provider, privacy during care, and information about medication were significantly associated with person-centered care (PCC) practices. Patients who did not know their healthcare provider were eight times more likely to rate the care as poor (AOR: 8.77; 95% CI: 4.47–17.22) compared to their counterparts. Those who perceived poor privacy in the hospital were twelve-fold more likely to rate PCC as poor (AOR: 12.08; 95% CI: 6.61–22.09) than those who perceived good privacy. Similarly, patients who felt they received inadequate information about their medication were 4.4 times more likely to rate the care as poor (AOR: 4.41; 95% CI: 2.41–8.05) compared to those who felt adequately informed (Table 4).

In the overall adjusted model, hospital type, perceived intimacy with the provider, ease of accessing services, hospital attractiveness, privacy during care, and medication information were significantly associated with person-centered care practices. Patients from private hospitals were 56% more likely to perceive the care they received as good for person-centered care (PCC) than those from public hospitals (AOR: 0.44; 95% CI: 0.26–0.75). Patients who did not know their healthcare provider were 4.8 times more likely to rate the PCC interaction as poor (AOR: 4.80; 95% CI: 3.07–7.50) compared to those who knew their provider. Patients who found it difficult to access services were 3.4 times more likely to rate the care as poor for PCC than those who found it easy to access services (AOR: 3.36; 95% CI: 2.24–5.03). Patients who perceived the hospital as unattractive were 1.65 times more likely to rate the care as poor for PCC (AOR: 1.65; 95% CI: 1.05–2.59) compared to those who found the hospital appealing. Patients who believed the hospital had poor privacy were 11.21 times more likely to perceive the care as poor for PCC (AOR: 11.21; 95% CI: 7.38–17.04). Patients who felt they did not receive adequate education on medication were 2.5 times more likely to rate the care as poor for PCC than those who felt adequately informed (AOR: 2.25; 95% CI: 1.67–3.90) (Table 5).

This cross-sectional study assessed person-centered care practices, but factors such as participants' moods or personal issues during data collection may have influenced their responses, potentially affecting the accuracy of the findings. Additionally, the study was conducted in Addis Ababa, the capital city of Ethiopia, and its findings may not be easily generalized to other regions. Significant differences in infrastructure and the availability of skilled healthcare professionals across regions may limit the applicability of the results.