The knowledge-perception nexus: socio-linguistic disparities in surgical informed consent among patients at Ethiopian tertiary hospitals

Surgical informed consent (SIC), the ethical bedrock of patient autonomy is undermined by profound sociodemographic disparities in resource-limited settings. This study aimed to evaluate the knowledge-perception nexus and sociolinguistic determinants of SIC comprehension among surgical patients in Ethiopian tertiary hospitals. This institution-based cross-sectional study was conducted among 412 surgical patients in Addis Ababa tertiary hospitals between March 8 to April 30, 2023. The validated interviewer-administered questionnaire was used to assess knowledge and perceptions. Descriptive statistics were used to summarize participant characteristics, and multivariable logistic regression identified predictors (P < 0.05). Only 52.2% demonstrated adequate SIC knowledge; 57.8% had positive perceptions. strongest knowledge predictors were higher education (AOR = 5.21, 95% CI: 3.12–8.68), prior surgery (AOR = 4.58, 95% CI: 2.87–7.32), male sex (AOR = 2.28, 95% CI: 1.52–3.42), and native-language proficiency (AOR = 1.83, 95% CI: 1.09–3.07). Favorable perception associated with urban residence (AOR = 3.99, 95% CI: 2.34–6.80) and marriage (AOR = 1.79, 95% CI: 1.16–2.78). Adequate knowledge independently predicted positive perception (AOR = 1.64, 95% CI: 1.02–2.62), explaining 68% of perception variance. Surgical patients in Ethiopia demonstrated inadequate knowledge and perceptions of informed consent, influenced by gender, education, residence, and language barriers. The association between knowledge and perception highlights the need for culturally appropriate interventions, including teach-back methods and shared decision-making to improve informed consent practices and surgical care outcomes in resource-limited settings.