How to Assess Inpatient Dignity With the APREMDI Scale
How can clinicians use the APREMDI scale to assess hospitalized patients' perceptions of dignity?
Hospitalized patients can experience subtle losses of privacy, autonomy, identity, and respect that routine satisfaction measures may not capture. This guide applies to adult psychiatric, medical, and surgical inpatients in Brazilian hospital settings where teams want a structured patient-reported measure of dignity to inform quality review, ethics oversight, or staff training.
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Confirm that the patient is eligible to complete the scale
Use the APREMDI with adults aged 18 years or older who have been hospitalized for at least 1 day or were discharged within the previous 30 days and are able to understand and answer the items. Do not use it in patients who decline participation, withdraw consent, are illiterate, or have cognitive impairment, delirium, or dementia, because these groups were excluded from validation.
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Plan administration in a private setting
Administer the scale through an interview conducted in a private environment to support comfort and confidentiality, mirroring the study procedure. Collect the response along with basic contextual variables the study tracked, such as age, sex, education level, ward type, hospital, length of hospitalization, and time to complete the scale, if your goal is service evaluation.
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Use the 19-item APREMDI across all dignity domains
Apply the full 19-item APREMDI rather than selected questions, because the validated instrument was tested as a whole. The scale rates 6 dimensions of dignity on a 1 to 5 Likert scale: privacy/intimacy, integrity, identity, information, respect, and consideration.
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Allow enough time and check comprehension
Expect the instrument to take about 1.08 to 1.35 minutes on average to read, while recognizing that some patients may take longer. Because readability indices suggested moderate complexity and suitability for readers with at least a high school education, be alert to possible comprehension barriers and consider an assisted format if literacy is limited.
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Interpret the result as an overall dignity measure with domain-level detail
Use the APREMDI to capture a general perception of dignity while also reviewing its 6 conceptual domains for targeted concerns. The study found both a 6-factor structure and strong evidence of a general dignity factor, supporting practical use of total scores while preserving domain-specific interpretation for quality improvement.
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Pair dignity assessment with anxiety review
When APREMDI scores suggest poorer perceived dignity, also assess anxiety symptoms because higher anxiety was the only significant predictor of lower dignity perception in regression analysis. In this sample, anxiety measured by HADS-A was negatively associated with APREMDI scores, with beta = -0.17 and P = .031.
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Use findings to guide ward-level improvement
Feed APREMDI results back into quality assessment, ethics review, satisfaction assessment, or staff training focused on humanized care and communication. The article supports using the scale across psychiatric, medical, and surgical units to identify respect-related problems and areas where institutional practice may be compromising dignity.
Clinical Considerations
- The validation sample was a convenience sample from 3 tertiary hospitals in southeastern Brazil, so generalizability to other Brazilian regions or populations may be limited.
- The scale appears best suited for patients with at least a high school education and may require simplification or assisted administration in lower-literacy settings.
- The instrument was not validated in illiterate patients or in patients with cognitive impairment, delirium, or dementia, because these groups were excluded.
- Self-report responses may be influenced by social desirability or power dynamics, particularly in psychiatric settings.
Bottom Line
Use the full APREMDI in eligible adult inpatients as a brief, structured patient-reported measure of dignity, and review low scores alongside anxiety symptoms to target improvements in respectful inpatient care.
