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Impact of Community Ambulance Awareness on Emergency Ambulance Service Utilization in Rural Nigeria

Abstract

Emergency ambulance services are an important component of emergency healthcare systems because they provide rapid transportation, basic or advanced prehospital care, and timely referral for individuals experiencing serious illness, injury, obstetric emergencies, road traffic crashes, and other life-threatening conditions. In rural Nigeria, however, emergency ambulance services may be underutilized because community members have limited awareness of available ambulance services, uncertainty about how to request an ambulance, misconceptions about ambulance eligibility and cost, reliance on informal transportation, poor knowledge of emergency numbers, and limited understanding of the role of ambulance services in prehospital care. Community ambulance awareness provides an opportunity to improve knowledge of emergency ambulance services and promote appropriate utilization when urgent medical transportation is required. Against this background, this study investigates the impact of community ambulance awareness on emergency ambulance service utilization 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 community members' perceptions of emergency health risks, perceived severity, perceived benefits of ambulance use, perceived barriers, self-efficacy, and cues to action may influence emergency service utilization. Andersen's Behavioral Model explains healthcare utilization through predisposing characteristics, enabling resources, and perceived need for healthcare services. The Social Ecological Model emphasizes the influence of individual, household, community, healthcare-system, and environmental factors on access to and utilization of emergency ambulance services. Collectively, these theoretical perspectives provide a suitable framework for explaining how community ambulance awareness may influence emergency ambulance service utilization 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. Community ambulance awareness will be assessed using indicators such as awareness of available ambulance services, knowledge of ambulance functions, knowledge of emergency contact numbers, understanding of situations requiring ambulance assistance, knowledge of how to request an ambulance, awareness of ambulance response procedures, understanding of whether ambulance services are free or fee-based where applicable, knowledge of appropriate information to provide when requesting an ambulance, awareness of prehospital care provided by ambulance personnel, knowledge of referral procedures, and awareness of limitations and appropriate alternatives when ambulance services are unavailable. Emergency ambulance service utilization will be assessed using indicators such as previous use of ambulance services during emergencies, willingness to request an ambulance when appropriate, actual ambulance requests, proportion of eligible emergencies transported by ambulance, timely activation of ambulance services, appropriate use of emergency contact numbers, acceptance of ambulance referral, and use of ambulance services for situations requiring urgent medical transportation. Data will be collected using structured questionnaires, emergency-service awareness assessment tools, ambulance utilization records where available, community emergency-response scenarios, 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, emergency healthcare experiences, awareness of ambulance services, accessibility, transportation preferences, and patterns of ambulance 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 impact of community ambulance awareness on emergency ambulance service utilization. Where a quasi-experimental design is adopted, ambulance-utilization indicators before and after the awareness 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 community ambulance awareness has a significant positive impact on emergency ambulance service utilization in rural Nigeria. Adults exposed to structured and practical ambulance-awareness education are expected to demonstrate greater knowledge of available emergency transportation services and a higher likelihood of appropriately requesting and utilizing ambulance services during emergencies than adults without comparable exposure. Education may improve community members' ability to recognize emergencies requiring ambulance assistance, identify appropriate emergency contact channels, provide relevant information when requesting an ambulance, and understand the importance of timely prehospital care. Community demonstrations, emergency-response scenarios, public awareness campaigns, and collaboration with community leaders may further improve confidence in using ambulance services. However, limited ambulance availability, poor road networks, long response times, inadequate emergency communication systems, financial barriers, geographical distance, shortage of trained personnel, and continued reliance on private or informal transportation may reduce the effectiveness of awareness alone. The study therefore expects accessible, community-based, culturally appropriate, and sustained ambulance awareness programmes, supported by functional emergency medical services, to contribute significantly to improved emergency ambulance service utilization in rural Nigeria. The study is expected to contribute to the literature on emergency medical services, ambulance utilization, community health education, prehospital care, emergency preparedness, rural healthcare, healthcare-seeking behaviour, emergency transportation, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Emergency Medical Treatment Committee, state ministries of health, emergency medical services, hospitals, primary healthcare centres, local government health authorities, community health workers, traditional and community leaders, development partners, public health practitioners, and policymakers regarding strategies for strengthening rural emergency healthcare systems. The study will also provide evidence-based recommendations for expanding community awareness of ambulance services, improving knowledge of emergency contact procedures, strengthening community emergency-response education, improving ambulance availability and response systems, establishing effective referral pathways, and developing sustainable emergency medical service programmes that promote timely and appropriate ambulance utilization across rural Nigeria.

Keywords: Community ambulance awareness, emergency ambulance service utilization, emergency medical services, rural communities, prehospital care, emergency healthcare, health education, healthcare utilization, emergency preparedness, Nigeria, public health.