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Impact of Universal Health Coverage Education on Healthcare Service Utilization among Low-Income Households in Nigeria

Abstract

Universal Health Coverage (UHC) aims to ensure that all individuals and communities can access needed quality health services without experiencing financial hardship. Despite ongoing efforts to expand health coverage in Nigeria, healthcare service utilization among low-income households remains a public health concern due to financial constraints, limited awareness of available healthcare programmes, misconceptions about healthcare entitlements, geographical barriers, transportation difficulties, and concerns about the quality and affordability of health services. Universal health coverage education provides individuals and households with information about the meaning and benefits of UHC, available healthcare services, health insurance and financial protection mechanisms, eligibility requirements, enrollment procedures, rights and entitlements, preventive healthcare, primary healthcare services, referral systems, and available channels for accessing healthcare. Healthcare service utilization refers to the actual use of available healthcare services by individuals and households, including preventive, promotive, curative, maternal and child health, diagnostic, and referral services. Effective UHC education may improve low-income households' understanding of available healthcare services and financial protection mechanisms and encourage timely and appropriate healthcare utilization. Against this background, this study investigates the impact of universal health coverage education on healthcare service utilization among low-income households in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and the Theory of Planned Behavior. The Health Belief Model provides a framework for understanding households' healthcare utilization decisions through perceived susceptibility to illness, perceived severity of health conditions, perceived benefits of available healthcare services, perceived barriers, and cues to action. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, household circumstances, healthcare environments, and healthcare-seeking behaviour. The Theory of Planned Behavior explains how attitudes toward healthcare utilization, perceived social expectations, and perceived behavioural control may influence households' intentions and actual decisions to utilize healthcare services. Collectively, these theoretical perspectives provide a suitable framework for explaining how UHC education may influence healthcare service utilization among low-income households in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from low-income households in selected Nigerian communities using a structured interviewer-administered questionnaire and healthcare service utilization assessment tool. A multistage sampling technique will be employed to select states, local government areas, communities, households, and eligible adult household representatives. Where feasible, selected communities or household groups will be assigned to intervention and comparison groups. Households in the intervention group will receive structured UHC education through community meetings, household sensitization, health talks, printed materials, audiovisual resources, and individual counselling. The education will cover the concept and benefits of UHC, available healthcare services, primary healthcare access, health insurance and financial protection, eligibility and enrollment procedures, healthcare entitlements, referral pathways, preventive healthcare, and appropriate healthcare-seeking. Healthcare service utilization will be assessed using indicators such as use of primary healthcare facilities, outpatient services, preventive healthcare, maternal and child health services, immunization, diagnostic services, treatment of common illnesses, and appropriate referral services. Additional indicators may include frequency of healthcare utilization, timeliness of care-seeking, usual source of healthcare, and use of available financial-protection mechanisms. Where feasible, self-reported utilization will be complemented by appropriate healthcare facility records or household documentation, subject to ethical and confidentiality requirements. Descriptive statistics will be used to summarize households' sociodemographic and economic characteristics, health insurance status, awareness of UHC, access to healthcare, and healthcare utilization patterns. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the impact of UHC education on healthcare service utilization. Where appropriate, utilization before and after the intervention will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, multicollinearity, and robustness of the findings. The study is expected to find that universal health coverage education has a significant positive impact on healthcare service utilization among low-income households in Nigeria. Households exposed to structured UHC education are expected to demonstrate improved understanding of healthcare entitlements, available services, financial protection mechanisms, and appropriate pathways for accessing healthcare. Education is expected to encourage greater utilization of primary healthcare, preventive services, maternal and child health services, diagnostic services, and appropriate treatment services. Increased knowledge of health insurance and other financial-protection mechanisms is also expected to reduce uncertainty about healthcare costs and encourage earlier healthcare-seeking. Community-based education delivered through trusted healthcare workers, community leaders, social organizations, and established community structures may be particularly effective in reaching low-income households. However, education alone may not guarantee sustained healthcare utilization because low-income households may continue to face barriers such as transportation costs, healthcare fees, limited availability of services, shortages of medicines and health workers, long distances to facilities, and perceived poor quality of care. Consequently, UHC education may be most effective when supported by affordable and accessible healthcare services, functional financial-protection mechanisms, adequate staffing, essential medicines and equipment, and effective referral systems. The study is expected to contribute to the literature on universal health coverage education, healthcare service utilization, low-income households, health financing, financial protection, health insurance, healthcare access, health education, health policy, and public health in Nigeria by providing empirical evidence on the impact of UHC education on healthcare utilization among economically disadvantaged households. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Health Insurance Authority, National Primary Health Care Development Agency, state health insurance agencies, state ministries of health, local government health authorities, healthcare facilities, community health workers, public health practitioners, health educators, development partners, and policymakers regarding strategies for improving equitable access to healthcare. The study will also provide evidence-based recommendations for strengthening UHC education, expanding community-based health-information programmes, improving awareness of health insurance and financial-protection mechanisms, simplifying healthcare access procedures, strengthening primary healthcare services, and promoting equitable and timely utilization of healthcare services among low-income households in Nigeria.

Keywords: Universal health coverage education, healthcare service utilization, low-income households, Nigeria, universal health coverage, healthcare access, health financing, financial protection, health insurance, primary healthcare, health education, health-seeking behaviour, health policy, public health.