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Effect of Primary Healthcare Service Education on Appropriate Use of Primary Healthcare Centres among Adults in Rural Nigeria

Abstract

Primary healthcare centres (PHCs) are an important component of the Nigerian health system and provide essential services such as health promotion, disease prevention, maternal and child healthcare, immunization, treatment of common illnesses, health education, and referral services. Appropriate utilization of PHCs can improve access to essential healthcare, promote early treatment, reduce preventable complications, and strengthen community-based healthcare. However, adults living in rural communities may underutilize PHCs or use them inappropriately because of limited knowledge of available services, misconceptions about primary healthcare, perceived poor quality of care, financial constraints, transportation difficulties, cultural beliefs, and preference for informal healthcare providers. Primary healthcare service education provides an opportunity to improve adults' understanding of the services available at PHCs and promote appropriate healthcare-seeking and utilization practices. Against this background, this study investigates the effect of primary healthcare service education on appropriate use of primary healthcare centres among adults in rural Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and Social Ecological Model. The Health Belief Model explains how adults' perceptions of susceptibility to illness, perceived severity, perceived benefits of using PHCs, perceived barriers, and cues to action may influence healthcare-seeking behaviour. Andersen's Behavioral Model explains healthcare utilization through predisposing factors, enabling resources, and perceived or evaluated need for healthcare services. The Social Ecological Model emphasizes the influence of individual, family, community, healthcare-system, and broader environmental factors on access to and utilization of primary healthcare services. Collectively, these theoretical perspectives provide a suitable framework for explaining how primary healthcare service education may influence appropriate use of PHCs among adults in rural Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 18 years and above residing in selected rural communities in Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, rural communities, households, and eligible adults. Primary healthcare service education will be assessed using indicators such as exposure to PHC education sessions, frequency and duration of education, knowledge of available PHC services, awareness of maternal and child health services, immunization, health screening, treatment of common illnesses, health promotion, disease prevention, family planning, health education, referral services, emergency care, operating hours, service costs, and awareness of appropriate points of entry into the healthcare system. Appropriate use of PHCs will be assessed using indicators such as seeking care at PHCs for appropriate health conditions, utilization of preventive health services, timely presentation for common illnesses, attendance for routine health screening, use of immunization and health-promotion services where applicable, appropriate use of maternal and reproductive health services, compliance with referral recommendations, avoidance of unnecessary self-medication or inappropriate informal healthcare use when PHC services are appropriate, and timely referral to higher-level facilities when necessary. Data will be collected using structured questionnaires, PHC service knowledge assessment tools, healthcare-utilization records where available, scenario-based healthcare-seeking assessments, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize participants' demographic and socioeconomic characteristics, healthcare-seeking patterns, knowledge of PHC services, accessibility, and patterns of PHC utilization. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of primary healthcare service education on appropriate use of PHCs. Where a quasi-experimental design is adopted, appropriate-utilization scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that primary healthcare service education has a significant positive effect on appropriate use of PHCs among adults in rural Nigeria. Adults exposed to structured and practical PHC education are expected to demonstrate greater knowledge of available services and a higher likelihood of appropriately utilizing PHCs than adults without comparable exposure. Education may improve participants' understanding of preventive and curative services, appropriate timing for seeking care, referral procedures, and the role of PHCs as the first point of contact with the healthcare system. Community-based education may also improve awareness of available services and reduce misconceptions regarding PHC facilities. However, poor road networks, transportation difficulties, inadequate staffing, medicine shortages, long waiting times, perceived poor quality of services, financial barriers, cultural beliefs, and limited availability of PHC services may reduce the effectiveness of education alone. The study therefore expects accessible, practical, community-based, and culturally appropriate primary healthcare service education, supported by improved quality and availability of PHC services, to contribute significantly to improved and appropriate use of primary healthcare centres among adults in rural Nigeria. The study is expected to contribute to the literature on primary healthcare utilization, healthcare-seeking behaviour, health education, rural healthcare, community health, health-service accessibility, preventive healthcare, health promotion, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, local government health authorities, primary healthcare centres, healthcare professionals, community health workers, traditional and community leaders, development partners, public health practitioners, and policymakers regarding strategies for improving utilization of primary healthcare services in rural communities. The study will also provide evidence-based recommendations for expanding community-based PHC education, improving awareness of available services, strengthening referral systems, addressing misconceptions about PHCs, improving accessibility and quality of primary healthcare services, and developing sustainable health-education programmes that promote appropriate use of primary healthcare centres across rural Nigeria.

Keywords: Primary healthcare service education, appropriate use, primary healthcare centres, adults, rural communities, healthcare utilization, healthcare-seeking behaviour, health education, primary healthcare, Nigeria, public health.