A questionnaire was distributed amongst staff to determine the existence and extent of harassment in the studied hospital. Harassment wasn’t recognized as a problem by 45.8% of hospital staff. However, participants felt harassment was a serious issue. It is therefore recommended that substantial actions be taken to reduce harassment. A transparent, widely known, valid, readily accessible, and effective system for complaints is needed.
Harassment is “the act of systematic and/or continued unwanted and annoying actions of one party or a group, including threats and demands” [
This study aims to address harassment at a Saudi university hospital in general. The focus however, was on medical students, interns and residents in a Saudi university hospital, which makes this study unique. Harassment may be widely underestimated due to the social structure the conservative Saudi culture.
500 quantitative, cross sectional questionnaires (Appendix 1) were distributed amongst all residents in training, interns and 5th year medical students in the tertiary care unit of the university hospital. Prior to that, a pilot questionnaire was adapted after reviewing previous publications [
Roughly, two thirds of participants (62%) reported being a victim of harassment. Of these, 31% were sub-interns, 40.8% were interns, and 28.2% were residents (
Type of Harassment | Position | p-value | Gender | p-value | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
5th year students | Interns | Residents | Male | Female | ||||||||
# | % | # | % | # | % | # | % | # | % | |||
Inappropriate jokes/comments | 37 | 84.1 | 37 | 63.8 | 27 | 67.5 | 0.021 | 46 | 68.7 | 55 | 75.3 | 0.103 |
Inappropriate gestures | 16 | 36.4 | 26 | 44.8 | 16 | 40.0 | 0.652 | 25 | 37.3 | 31 | 42.5 | 0.223 |
Verbal abuse | 12 | 27.3 | 17 | 29.3 | 15 | 37.5 | 0.225 | 28 | 41.8 | 16 | 21.9 | 0.012 |
Racial discrimination | 11 | 25.0 | 11 | 19.0 | 7 | 17.5 | 0.165 | 15 | 22.4 | 14 | 19.2 | 0.365 |
Stalking | 5 | 11.4 | 14 | 24.1 | 5 | 12.5 | 0.025 | 11 | 16.4 | 13 | 17.8 | 0.58 |
Undesirable physical contact/unwanted touch | 12 | 27.3 | 11 | 19.0 | 7 | 17.5 | 0.185 | 11 | 16.4 | 17 | 23.3 | 0.62 |
Gender discrimination | 0 | 0.0 | 1 | 1.7 | 1 | 2.5 | 0.822 | 1 | 1.5 | 1 | 1.4 | 0.65 |
Bothersome phone calls | 1 | 2.3 | 0 | 0.0 | 1 | 2.5 | 0.741 | 0 | 0.0 | 2 | 2.7 | 0.52 |
Total any type of harassment | 44 | 58 | 40 | - | 67 | 75 | - |
plaints with 3.5% and 0.7% respectively. Age also had a significant effect on incidence, with 94.1% of sufferers being in their 20s, 5.2% in their 30s. Details of harassers are shown in
As defined in the introduction, harassment may include all forms of unwanted attention or actions and is not restricted to undesired sexual advancements. Most studies conducted in the past looked at harassment in nurses, and focused on sexual harassment specifically. Our study is unique as it looked at a broader
Harasser | Male | Female | Unspecified gender | Total | p-value | ||
---|---|---|---|---|---|---|---|
# | % | # | % | ||||
Student | 22 | 59.5 | 10 | 27.0 | 5 | 37 | 0.013 |
Intern | 12 | 46.2 | 10 | 38.5 | 4 | 26 | 0.225 |
Resident | 23 | 67.6 | 11 | 32.4 | 0 | 34 | 0.011 |
Team member | 13 | 65.0 | 5 | 25.0 | 2 | 20 | 0.0065 |
Patients | 36 | 66.7 | 10 | 18.5 | 8 | 54 | 0.001 |
Nurses | 3 | 17.6 | 11 | 64.7 | 3 | 17 | 0.001 |
Consultant | 54 | 66.7 | 13 | 16.0 | 14 | 81 | 0.012 |
Patient relatives and friends | 29 | 50.9 | 14 | 24.6 | 14 | 57 | 0.028 |
Administrative staff | 15 | 62.5 | 5 | 20.8 | 4 | 24 | 0.015 |
Laboratory staff | 2 | 100 | 0 | 0.0 | 0 | 2 | 0.001 |
Porter | 1 | 100 | 0 | 0.0 | 0 | 1 | - |
Unspecified position | 12 | 70.6 | 5 | 29.4 | 0 | 17 | 0.001 |
Reasons for not reporting | # | % | Ranking |
---|---|---|---|
I felt ashamed | 9 | 7 | 6 |
Incidence didn’t affect me/I saw no need to report | 69 | 53.1 | 1 |
I feared the harasser’s revenge | 15 | 11.5 | 5 |
I didn’t know what action to take | 39 | 30 | 2 |
I thought it would make my work situation unpleasant | 29 | 22.3 | 3 |
I thought it would be held against me or that I would be blamed | 27 | 20.8 | 4 |
I did not want to hurt the person who bothered me | 15 | 11.5 | 5 |
There was no security around | 1 | 1.9 | 8 |
Thought no action would be taken | 2 | 3.7 | 7 |
I told the harasser about the policy in the hospital and never saw him again | 1 | 1.9 | 8 |
Thought it would affect my marks | 1 | 1.9 | 8 |
Thought it is the rule of the country (females are inferior) | 1 | 1.9 | 8 |
The patient was elderly | 1 | 1.9 | 8 |
Type of Harassment | # | % | Ranking |
---|---|---|---|
Inappropriate jokes/comments | 17 | 44.7 | 1 |
Inappropriate gestures | 4 | 10.5 | 3 |
Verbal abuse | 9 | 23.7 | 2 |
Racial discrimination | 2 | 5.3 | 4 |
Stalking | 4 | 10.5 | 3 |
Undesirable physical contact/unwanted touch | 2 | 5.3 | 4 |
definition of harassment and across a myriad of academic levels and professional positions.
There is a higher prevalence of harassment than that acknowledged by the hospital community. 45.8% of participants stated that harassment was not a problem. While 62% said that they had been victims of harassment. This could be attributed by the sensitivity of this topic in Saudi Arabia in general. It is heavily influenced by conservative cultural norms and lack of transparency.
The frequency of harassment was lower than expected from the various literature reviews although it did exceed the stated threshold for concern. This is a problem of any study that is dependent on subjectivity. The results rely heavily on the definition used, the sample size and the particular group of people asked. One hospital reported over 75% harassment, but the sample size was merely 58 individuals [
The professional status of the individual showed to have a significant role in the frequency of reported harassment. Interns were the most likely to be harassed, followed by 5th year students and residents were found to be the least prone. This could be due to the interns’ position at the bottom of the professional medical hierarchy, coupled with the highest hospital hours. Students in their 5th year (sub-interns) ranked second. Senior staff frequently tests them during rounds. Patients also frequently ask 5th year students for information. The discrepancies between the expectations of senior staff and patients on one hand and the actual knowledge level of students may contribute to a feeling of harassment. Residents were harassed the least, but made up a percentage that could not be overlooked (28.2%). This may be because residents have a strong knowledge base and realize that the university hospital depend on them which gives them confidence.
Gender was also associated with the prevalence of harassment. Females were at a higher risk of being harassed than males. This could be due to the stereotype that put females at risk for being bothered generally and male prejudice that is embedded in society. Not surprisingly, these results were consistent with published literature.
When correlating age with the prevalence of harassment, most of our participants fell into the 20s and 30s group. A younger age showed an association with increased risk of harassment, as those in their 20s was more likely to be harassed than those in their 30s. Published literature draws a parallel result, as younger nurses were more likely to get harassed [
Finally, harassment is an existent and serious issue that needs to be tackled. The interpretation and reporting of harassment is subjective, therefore the results can never be used for an absolute conclusion on prevalence or for comparing harassed groups. Future studies may use an interview-based prospective study, to minimize subjectivity & recall bias. Hospital policy on harassment should be transparent and enforced. Additionally, there should be significant steps to disseminate the policy using continuous repetitive seminars, multimedia, and on hospital screens in the hallways, waiting rooms & lobbies, and hospital ward and office computers.
Harassment is an existent and serious issue. Although it is difficult to measure, there is a higher prevalence of harassment than recognized by the community in the studied hospital. An increased incidence of harassment was reported against interns and females. Younger age & junior staff were at a higher risk. Policies on this matter, in all institutes, should be made clear with continuous education of all employees, students, patients and their relatives.
We would like to thank the College of Medicine Research Center (CMRC) for their support.
Aljerian, K., Almadani, A. and Alharbi, S.S. (2017) Study on the Existence and Extent of Harassment among Medical Staff in a Saudi University Hospital. Open Journal of Social Sciences, 5, 45-55. https://doi.org/10.4236/jss.2017.56006
We are researchers who would like to assess the existence and extent of harassment in sub-interns, interns and residents at King Khalid University Hospital (KKUH). The KSU IRB has approved our study. We would like to assure that all the information will be handled confidentially. Your participation is much appreciated. Your participation is voluntary, and you may withdraw at any time. Harassment is the act of systematic and/or continued unwanted and annoying actions of one party or a group, including threats and demands. Examples of harassment:
If you would like to participate, please sign:
Signature of the participant: _________________________________
Name of the researcher: ____________________________________
Serial number (by the researcher): ____________________________
(1) Position:
a) Sub-intern/5th year student
b) Intern
c) Resident
d) R1
e) R2
f) R3
g) R4
h) R5
i) R6
j) Other
(2) Years of employment: _______year/s
(3) Gender:
a) Male
b) Female
(4) Age: _______years
(5) Residency/Postgraduate program:
(6) Sponsor: _______
(7) Marital status:
(8) Do you think harassment (as defined above) is a problem in King Khalid University Hospital (KKUH)?
(9) Have you ever been bothered by any of the following? (you may choose more than one)
(10) Who was the harasser? Tick the box and circle the gender you may choose more than one)
(11) At what time was the harassment? ( you may choose more than one)
(12) What was your response? (you may choose more than one)
o Reported an official complaint (please answer questions 13&14, then skip 15)
(13) After reporting, was an official action taken?
o Yes, what type of action? _______
o No
o Not applicable
(14) After reporting, what did the harasser do?
(15) If you did not report, why didn’t you report (you may choose more than one)?
(16) How were you affected by the incidence? (you may choose more than one)
(17) Do you know any one that has been harassed?
o Yes
o No
(18) Does your organization have a formal policy for dealing with harassment?
o Yes
o No
o I don’t know
(19) Would you like the policy of complaints to be distributed and well known to KKUH attendants?
o Yes
o No
o I don’t care
(20) Did you ever harass any one?
o Yes (If you answered “YES”, please answer the questions 21 - 23 also)
o No (If you answered “NO”, please go to question 24 directly)
(21) How did you harass them? (you may choose more than one)
(22) Why did you do it?
(23) Whom did you harass? Choose both position and gender (you may choose more than one)
(24) If you would like to share an experience or a story, please fill below:
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