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Impact of Endometriosis Support Services on Healthcare Service Utilization among Women with Endometriosis in Nigeria

Abstract

Endometriosis is a chronic gynaecological condition characterized by the presence of endometrial-like tissue outside the uterus and may be associated with pelvic pain, painful menstruation, pain during sexual intercourse, infertility, fatigue, and other symptoms that can significantly affect women's physical, psychological, social, and reproductive wellbeing. Women living with endometriosis may experience delays in diagnosis and treatment because symptoms can be misunderstood or normalized, while limited awareness, stigma, financial constraints, inadequate specialist services, and fragmented healthcare systems may further restrict access to appropriate care. Endometriosis support services, including counselling, patient education, peer support, pain-management guidance, reproductive health counselling, specialist referral, and follow-up services, may help women understand their condition and navigate available healthcare services. Against this background, this study investigates the impact of endometriosis support services on healthcare service utilization among women with endometriosis in Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Health Belief Model, and the Social Ecological Model. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and healthcare needs influence women's utilization of endometriosis-related healthcare services. The Health Belief Model explains how women's perceptions of the seriousness of endometriosis, perceived benefits of seeking appropriate care, perceived barriers, and cues to action may influence healthcare-seeking and service utilization. The Social Ecological Model emphasizes the interaction between individual, interpersonal, healthcare-system, community, and broader societal factors in determining access to and utilization of endometriosis support and healthcare services. Collectively, these theoretical perspectives provide a suitable framework for explaining how endometriosis support services may influence healthcare service utilization among women with endometriosis in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women with a confirmed or clinically diagnosed history of endometriosis attending selected hospitals, gynaecology clinics, specialist facilities, pain-management centres, reproductive health services, and endometriosis support programmes across Nigeria. A multistage sampling technique will be used to select states, healthcare facilities, support organizations, and eligible women. Endometriosis support services will be assessed using indicators such as availability of patient education, counselling, peer-support groups, pain-management guidance, reproductive health counselling, psychological support, specialist referral, treatment navigation, follow-up services, service accessibility, affordability, confidentiality, and continuity of care. Healthcare service utilization will be assessed using indicators such as frequency of healthcare visits, attendance at gynaecology consultations, specialist consultations, pain-management service utilization, diagnostic follow-up, treatment attendance, medication-related healthcare visits, reproductive health consultations, referral compliance, and follow-up attendance. Data will be collected using structured questionnaires, healthcare utilization records where appropriate, clinic attendance registers, referral records, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, availability and use of support services, and patterns of healthcare utilization. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of endometriosis support services on healthcare service utilization. Where a quasi-experimental design is adopted, healthcare utilization before and after implementation or expansion of support services may be compared, while relevant demographic, socioeconomic, disease-related, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that accessible and comprehensive endometriosis support services have a significant positive impact on healthcare service utilization among women with endometriosis in Nigeria. Women who receive structured education, counselling, treatment navigation, peer support, and appropriate referral assistance are expected to demonstrate greater utilization of relevant healthcare services than women with limited access to support. Support services may improve women's understanding of endometriosis, increase confidence in communicating symptoms to healthcare providers, encourage timely consultation, improve adherence to referrals and follow-up appointments, and facilitate access to specialist and reproductive healthcare. They may also help reduce the normalization of severe menstrual and pelvic pain and encourage women to seek professional evaluation. However, financial barriers, limited availability of specialist services, geographical distance, stigma, inadequate healthcare infrastructure, shortage of trained providers, and delays in diagnosis may continue to constrain healthcare utilization. The study therefore expects accessible, coordinated, patient-centred, and affordable endometriosis support services to contribute significantly to improved healthcare service utilization among women with endometriosis in Nigeria. The study is expected to contribute to the literature on endometriosis support services, healthcare service utilization, endometriosis management, women's reproductive health, chronic disease support, pain management, patient education, specialist healthcare, 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, hospitals, specialist gynaecology centres, healthcare providers, women's health organizations, endometriosis support groups, development partners, and policymakers regarding strategies for improving healthcare utilization among women living with endometriosis. The study will also provide evidence-based recommendations for strengthening endometriosis support programmes, improving patient education and treatment navigation, expanding access to specialist services, establishing coordinated referral and follow-up systems, training healthcare providers, improving pain and reproductive health management, and reducing financial and geographical barriers to appropriate endometriosis care across Nigeria.

Keywords: Endometriosis support services, healthcare service utilization, endometriosis, women, reproductive health, gynaecological healthcare, pain management, patient education, treatment navigation, specialist healthcare, Nigeria, public health.