Abstract
Background: Several factors influence maternal care-seeking decisions at primary healthcare facilities. Given the high maternal morbidity and mortality in northeast Nigeria, this study, rooted in the Social Ecological Model (SEM) of behaviour change, investigated the structural and cognitive barriers that limit antenatal and family planning care-seeking behaviour among households in Gombe State, Nigeria.
Method: Qualitative in-depth interviews (IDIs), each lasting 60-70 minutes, were conducted with 56 respondents, including mothers/expectant mothers (n=15), their household decision-makers/spouses (n=16), community leaders (n=16), and primary healthcare centre (PHC) service providers (n=9). The qualitative instrument was developed and analysed based on the four core elements of the SEM: individual, relational, institutional, and community-level factors. The study was conducted in Dukku, a rural local government area (LGA), and Yamaltu Deba, a peri-urban LGA.
Results: The findings indicate that the direct and indirect costs of care, service quality, and PHC proximity were the main supply-side barriers rooted in institutional-level factors. Most of the demand-side barriers were associated with individual (poor salience), relational (limited spousal support), and community-level (traditional maternal practices) factors of the SEM model. Optimism bias, overconfidence bias, and present bias are some of the demand-side psychological barriers that impede maternal care uptake. Similarly, supply-side barriers, such as poor quality of care, can significantly undermine individual and community-level demand for PHC-based maternal care.
Conclusion: The SEM model offers a comprehensive framework for understanding the complex, multi-layered factors influencing care-seeking behaviours toward antenatal care and family planning.