THE SOCIO-ECONOMIC FACTORS INFLUENCINGELDERLY WOMEN'S

UTILISATION OF PRIMARY HEALTHCARE SERVICES IN YABA LOCAL

GOVERNMENT AREA, LAGOS STATE

BY

ADESOLA TOLULOPE AKANMU

MATRIC NO:

110904021

A PROJECT PRESENTED TO THE SCHOOL OF POST GRADUATE STUDIES,

FACULTY OF SOCIAL SCIENCES, UNIVERSITY OF LAGOS, IN PARTIAL

FULFILMENT OF THE REQIREMENTS FOR THE AWARD OF MASTER’S DEGREE

IN PUBLIC AND INTERNATIONAL AFFAIRS (MPIA)

OCTOBER, 2023

i
 CERTIFICATION

This is to certify that this research work titled “The Socio-Economic Factors InfluencingElderly

Women's Utilisation of Primary Healthcare Services in Yaba Local GovernmentArea, Lagos State”

was carried out by Adesola Tolulope Akanmu with Matriculation Number: 110904021

under my supervision.

________________________ ________________________
PROF. FATAI BADRU DATE
(Project Supervisor)

________________________ ________________________
DR. AYODELE SHITTU DATE
(Coordinator, MPIA)

ii
 DEDICATION.

I am dedicating this to God Almighty for the grace and strength, to myself, my late father, my sweet

mother, and especially to “Adeamola Ojomo”, my sweet husband, whose support and dedication

made this research work a success.

iii
 ACKNOWLEDGEMENTS

First and foremost, I owe all gratitude to the Almighty God for the strength to complete this journey

in sound mind and health, and to my sweet husband, Adedamola Inumidun Ojomo, for his dedication

to me, this research work and my MPIA programme.

My heartfelt appreciation and gratitude go to my supervisor, Prof. Fatai Badru, for his patience,

articulation, thorough supervision and earnest guidance to ensure that this research work is error-free

and impactful.

I also wish to thank my guardian angels, my mum Mrs. Hikmat Akanmu, my late dad, Mr. Isaac

Akanmu, who would have been the happiest man alive with this achievement. To my second mother,

sweet mother-in-law, Ma Olafemi Ojomo, her constant support and prayers were valuable in this

journey.

I am highly indebted to all my MPIA lecturers whose teacings impacted me with knowledge, I have

now acquired.

I also wish to thank my wonderful friends and family, who all played big roles while on this journey.

Comfort Ajala, Modupe Akinyemi, Paul Ekkot, Damilola Ashabi, Ann Ojadi, Kay Kush, Endy, and

especially my four brothers, Olaita, Anu, Dare and Femi. I am grateful.

iv
 ABSTRACT

The study examined the socio-economic factors influencingelderly women's utilisation of primary
health centers in Yaba Local GovernmentArea, Lagos State. The study’s specific objectives include:
to examine the roles of socioeconomic status in the utilisation of primary health centers amongst
elderly women in Lagos Metropolis; to know whether the level of education will influence utilisation
of primary health centers amongst elderly women in Lagos Metropolis; to examine if area of
residence have significant influence on utilisation of primary health center amongst elderly women
in Lagos Metropolis; to find out if poor primary healthcare facilities was a significant predictor of
utilization of primary health centers amongst elderly women in Lagos Metropolis; and to know if
access to traditional medicine influences the utilisation of primary health centers amongst elderly
women in the Lagos metropolis. The research which adopted convenience sampling technique
sampled the opinions of twenty (20) hospital staff and twenty (20) elderly female patients across
four (4) Primary healthcare centers located within Yaba, LGA, Lagos State through the use of key
informant interview and in-depth interview.

The findings revealed several themes in respect of how socioeconomic status influences utilisation of
PHCs amongst elderly female patients, also education was shown to be a significant factor in
utilisation of PHCs amongst female elderly, equally findings indicted that area of residence was a
significant predictor of utilisation of PHC. Furthermore, results demonstrated that poor PHC
facilities discouraged elderly female patients from utilising the PHCs, just as access to traditional
medicine was identified as one of the factors, limiting the level of utilization of PHCs by elderly female
patients. The study finally provided some suggestions for future researchers while making key
recommendations for the Nigerian medical sector in order to enhance quality health care with
increased utilisation by all categories of patients, especially the vulnerable aged population.

v
 TABLE OF CONTENTS

Pages

Title page i

Certification ii

Dedication iii

Acknowledgements iv

Abstract v

Table of contents vi

CHAPTER ONE: INTRODUCTION

1.1 Background to the Study 1

1.2 Statement of the Problem 3

1.3 Objectives of the Study 3

1.4 Research Questions 4

1.5 Significance of the Study 5

1.6 Operational Definition of Terms 5

CHAPTER TWO: LITERATURE REVIEW

2.1 Conceptual Review 6

2.2 Theoretical Orientation 8
2.2.1 Health Belief Theory 8
2.2.2 Social Cognitive Theory 9
2.2.3 The Theory of Planned Behaviour (TPB) 10
2.2.4 The Anderson Behaviour Model (ABM) 12
2.3 Empirical Review 14
2.3.1 Locality and Utilization of PHC 14
2.3.2 Education and Utilization of PHC 16
2.3.3 Income and Utilization of PHC 16
2.3.4 Other Social-economic factors 17
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CHAPTER THREE: RESEARCH METHODOLOGY

3.0 Introduction 19
3.1 Research Design 19
3.2 Study Location 20
3.3 Population of the Study 25
3.4 Sample Size 25
3.5 Sampling Techniques 26
3.6 Sources of Data 26
3.6.1 Primary Data 27
3.6.2 Secondary Data 28
3.6.3 Instrument for Data Collection 28
3.7 Procedure 28
3.8 Method of Data Presentation/Analysis 32

CHAPTER FOUR: RESULTS AND DISCUSSION OF FINDINGS

4.0 Introduction 33
4.1 Discussion of Findings 51

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS.

5.1 Summary 57
5.2 Conclusion 58
5.3 Recommendations 58
5.4 Suggestions for Future Research 58
5.5 Contributions to Knowledge 59

References 60

Appendix 67

vii
 CHAPTER ONE

INTRODUCTION
1.1 Background to the Study

According to Omorogbe (2017), Nigeria is one of the first countries across the globe to ensure the

systematic delivery of healthcare services through Local Government Administration. Omorogbe

(2017) also observed that many Western countries prioritise socio-economic equity in the use of

primary healthcare. However, this is not the case with most African nations like Nigeria, where

evidence indicates that inequality across socio-economic classes manifests in utilising these services

(Phiri & Ataguba, 2014). Phiri and Ataguba (2014) likewise opined that education, economic status,

occupation and wealth, amongst other socio-economic indicators, play an essential role in the

utilisation of primary healthcare services, mainly in developing countries. Similarly, Omorogbe (2017)

asserted that socio-economic variables are vital predictors of effective utilisation of health services,

adding that elderly persons with better socio-economic conditions can have easier access to primary

healthcare services than poorer elderly persons (Omorogbe, 2017).

Oladigbolu et al. (2017), noted that proper use of primary healthcare services improves the health of

a community and the country at large. Also, Phiri and Ataguba (2014) in their study asserted that the

presence of a good healthcare facility is not enough to guarantee its effective use as many

socioeconomic factors play a role in determining the extent to which people utilise healthcare facilities.

However, the authors noted that “low health facility utilisation is often a reflection of poor quality of

services and poor attitude of the staff.” The apparent inequality in the accessibility of quality healthcare

in developing countries has renewed recent calls for improving the health status of the poor through

improved primary healthcare facilities as well as other intervention efforts by the government in

developing countries (Phiri & Ataguba, 2014).

1
Today, the population of the world has grown tremendously, tripling what it used to be in the mid-

twentieth century (United Nations Organisation, 2022). According to the report, in 2022, the global

population averaged about 8 billion from about 2.5 billion in 1950. In 2022, the population of Europe

and North America combined (1.1 billion) was almost the same as the population of sub-Saharan

Africa (1.2 billion) (UNO, 2022). Across the globe, persons above the age of 65 years are estimated

to outnumber persons below the age of five (5) years for the first time in 2018 (UNO, 2022). This

indicates that the aging population is growing rapidly, possibly because of development in modern

medicine, especially in developed countries. According to World Bank (2014), the Nigerian population

has continued to grow over the years. World Bank (2014) reported that “the country’s population rose

from 16.06 million in 1911 to 30.42 million in 1953 while rising further to 89 million in 1991 and to

over 170 million in 2014”. According to Worldometers (2023), an elaboration of the United Nations

data indicates that as of April 18, 2023, the Nigerian population is 220,384,001, while it is projected

to reach 375m in 2050.

According to the UNO (2022) report, globally, available data reveals that there are slightly more men

(50.3%) than women (49.7%) in 2022. However, globally, women are more in number than men at

age 65 years and above (United Nations Organisation, 2022). In 2022, 55.7% of persons aged 65 years

and older are women. According to the National Population Commission (2018), in Nigeria, all

citizens over the age of 60 years are classified as elderly. Hence, the total population of the elderly in

Nigeria,as published by the Commission, is estimated at 9,934,942. The male elderly stand at 5,542,258,

while their female counterparts stand at 4,392,684 (NBC, 2018). According to the Commission,

“Nigerian older population is expected to grow from over 9 million in 2016 to 26 million by 2050”

(National Bureau of Statistics, 2018).

2
1.2 Statement of the Problem

The elderly women’s population is increasing globally, especially in developed countries, not only

because of advancements in modern medicine but also due to relative improvements in socioeconomic

conditions that aid longevity and increase in the utilisation of primary healthcare services. However,

this situation does not replicate a global uniformity in respect of the utilisation of health amenities,

particularly in Nigeria, where poverty and low policy implementation lead to the exemption of elderly

women in primary healthcare coverage compared to what is obtainable in other parts of the world,

especially the developed countries. Exclusion with respect to equitable access to basic social amenities

and food security are characteristics of elderly persons in Nigeria. Recent research has acknowledged

that income is a good predictor of quality health (Caballo et al., 2021). Incidentally, globally, Nigeria

has one of the highest rates of death amongst the elderly, as reported by Uchedu and Forae (2013),

who, in their study, found that the mortality rate of the elderly aged 65-69 years was about 26.2%. This

condition could be attributed to the poor economic condition of the elderly persons in Nigeria and the

poor implementation of the National Senior Citizens Centre (NSCC) Act, 2017 of the Federal Republic

of Nigeria, which makes specific provisions to address the welfare needs of elderly persons. Given the

high death rate amongst the elderly in Nigeria as occasioned by a lack of adequate access to healthcare

services, the study, therefore, attempts to investigate the socioeconomic factors influencing the

utilisation of primary healthcare services amongst elderly women in the Lagos Metropolis.

1.3 Objectives of the Study

Generally, the study is aimed at examining the socioeconomic variables that can influence elderly

women’s utilisation of primary healthcare services in the Yaba Local Government Area of Lagos State.

Specifically, the study aims to achieve the following objectives:

i.To examine the roles of socioeconomic status in the utilisation of primary healthcare amongst

3
 elderly women in Lagos Metropolis.

ii.To know whether the level of education will influence the utilisation of primary healthcareamongst

elderly women in Lagos Metropolis.

iii.To examine if the participant’s area of residence will have a significant influence on the

utilisation of primary healthcare amongst elderly women in Lagos Metropolis.

iv.To find out if poor primary healthcare facilities will be a significant predictor of utilisation of

primary healthcare amongst elderly women in Lagos Metropolis.

v.To know if access to traditional medicine influences the utilisation of primary health careamongst

elderly women in the Lagos metropolis.

1.4 Research Questions

1. Will socioeconomic status play a role in the utilisation of primary healthcare amongstelderly

women in Lagos Metropolis?

2. Will the level of education influence the utilisation of primary healthcare amongst elderly women

in Lagos Metropolis?

3. Does the respondent’s area of residence have a significant influence on the utilisation ofprimary

healthcare amongst elderly women in Lagos Metropolis?

4. Will poor primary healthcare facilities be a significant predictor of utilisation of primaryhealthcare

amongst elderly women in Lagos Metropolis?

5. Will access to traditional medicine influence the utilisation of primary health care amongstelderly

women in the Lagos metropolis?

4
1.5 Significance of the Study

The study will allow policymakers to know and understand the variables that affect the effective use

of primary healthcare facilities by Lagos state residents, particularly elderly women. This will give
them insight into the needed changes that should be initiated to have improved primary healthcare as

the most basic source of healthcare available to an average Nigerian. The study will also contribute to

the existing literature on factors influencing people’s use of primary healthcare in developing

countries. It will therefore, serve as a reference point for future researchers.

1.6 Operational Definition of Terms

Area of Residence: In this study, this means a participant's place of residence. The study defines the

area of residence according to the proximity of the participant's place of residence to the primary

healthcare facility.

Elderly Persons: These are persons who are 60 years of age and above.

Level of Education: This is a participant's highest educational attainment. It will also be categorized

into high and low levels of education.

Primary Healthcare Services: According to WHO (2022), Primary Healthcare (PHC) is "a whole-

of-society approach to effectively organize and strengthen national health systems to bring services

for health and wellbeing closer to communities." The present study wishes to adopt this definition.

Socio-economic Factors: Socio-economic status (SES), as defined by the American Psychological

Association (2018), simply refers to the social status of an individual that is often measured by

income, education, and occupation. This study will measure SES according to the participants' level

of monthly earnings as well as their level of education.

Traditional Healers: This simply means the local healers that deal in the production and sale of

herbs to clients.

5
 CHAPTER TWO
LITERATURE REVIEW

This section was divided into three: the conceptual review, empirical review, and theoretical review.

While the conceptual review discussed the concepts of healthcare utilisation according to the literature,

the empirical review focused on different empirical research that has been done on socioeconomic

factors affecting the utilisation of primary healthcare. Lastly, the theoretical review examined some

theories that explain the dependent variable (utilisation of primary healthcare). Meanwhile, the

independent variables include income, education level, residence area, poor healthcare facility, and

level of patronage of herbal medicine. In contrast, the dependent variable is the participant’s level of

utilisation of primary healthcare.

2.1 Conceptual Review

According to Cueto (2004), the Primary health centre (PHC) is the closest health facility to the

grassroots, just as it is the first point of call for families, mainly in rural communities in Nigeria’s

national healthcare system. It is the first step in the Government’s ongoing process to provide

healthcare to the people due to its efforts to bring healthcare close to homes and places of employment

(Cueto, 2004). As reported by (Gideon, 2014), “the paradigm of health care delivery officially shifted

in 1978 from a hospital-based vertical approach to a grassroots primary health care approach through

the International Conference on Primary Health Care (PHC), which took place in Alma Ata,

Kazakhstan, USSR, from September 6 to 12, 1978 at which 134 countries of World Health

Organisation were represented” (p. 17).

6
The extent and usage patterns of healthcare services are referred to as utilisation. The performance of

PHC in enhancing population health in rural communities in Nigeria is severely hampered by poor or

under-utilisation of PHC services (Onwujekwe & Uzochukwu, 2005).

As the first point of call in a country’s national healthcare, PHC mainly plays a preventive, curative,

rehabilitative, and promotive role while providing comprehensive and integrated services through

links with other levels of care (Gulliford, 2002).

Primary healthcare is a lower-level endeavour to provide everyone with equal and universal access to

healthcare, as stated in the Alma-Ata Declaration of 1978. This strategy aims to bring health care as

close to people as possible as a foundation for ensuring their ongoing medical care by offering

promotive, preventive, corrective, and rehabilitative treatments. In addition, it is intended to address

the major health issues in the community. In other words, it aims to provide all the health services that

families, people, and communities require, aside from those that can only be offered in hospitals

(Federal Ministry of Health Nigeria, 2004). Five guiding principles for primary healthcare are outlined

in the Alma-Ata Declaration and are intended to operate in concert with one another to improve society

as a whole. These concepts were described by Pemberton and Cameron (2010) and encompass inter-

sectoral cooperation, community involvement, health promotion, and accessibility.

Although PHC is widely acknowledged as a requirement for community health change, the utilisation

and status of PHC facilities in several developing nations, particularly Nigeria, go against global norms

and best practices. Therefore, the provision of primary healthcare services (PHC) of high quality can

have a significant impact on Nigerians’ health, particularly that of the senior population.

According to Newbrander et al. (2020), the socio-economic environment in which most PHC facilities

operate has been established as a significant factor in their performance and patronage. According to

a previous study, “while policymakers have often used individual characteristics like neglectfulness,

7
irresponsibility, distrust, and ignorance to blame citizens for the under-utilisation of PHC services in

rural areas, blaming the poor or unmotivated clients does not take one very far, as this will not uncover

the root causes of failure” (Starfield, 2017).

2.2 Theoretical Orientation

The section will discuss the theories used to explain utilisation of primary health care. Four theories

will be reviewed, including the health belief model, social cognitive theory, theory of planned

behaviour, and the Andersen Behavioral Model (ABM). These theories will be discussed to understand

the concept of health utilisation better.

2.2.1 Health Belief Theory

This theory primarily describes why people use primary health services. This model states that people

will seek medical attention if they feel at risk for a health issue and that taking the suggested action

will lessen their risk or the severity of the issue (Dewi & Umijati, 2020). The Health Belief Model is

anchored on four key factors: “perceived susceptibility, perceived severity, perceived benefits, and

perceived barriers” (Dewi & Umijati, 2020, p. 27).

Perceived susceptibility: refers to a person’s opinion of the propensity to experience a health issue.

People are more likely to seek primary healthcare services to prevent or treat a condition if they believe

they are at high risk.

Perceived severity: refers to a person’s perception of the gravity of a health issue. A person is more

likely to seek primary healthcare services to prevent or treat a health issue if they think it is serious.

Perceived benefits: relate to a person’s opinion regarding the efficiency of advised medical services

in avoiding or treating a health issue. People are more inclined to seek primary healthcare services if

they think the advised medical care will be successful.

8
Perceived barriers: refer to a person’s perception of the costs or difficulties involved in using basic

healthcare services. People may be less likely to access basic healthcare services if they think doing

so will be difficult or expensive.

Generally, the Health Belief Model contends that an individual’s decision to utilize primary healthcare

services is largely determined by their perceptions about their vulnerability to health issues, the gravity

of those issues, the advantages of doing so, and the drawbacks of doing so (Pálsdóttir, 2008).

Therefore, primary healthcare services can be made more appealing and available to people by taking

care of these issues, promoting increased use and enhancing general health outcomes (Pálsdóttir,

2008).

2.2.2 Social Cognitive Theory

The social cognitive theory was propounded by Albert Bandura, a social psychologist (Bandura,

2006). Social Cognitive Theory (SCT) argues that people's behaviour is influenced by their

characteristics, social environment, and cognitive processes (Glanz, et al., 2015). According to SCT,

individuals' behaviour is not solely determined by external factors but also by their beliefs, goals, and

self-efficacy.

In the context of primary healthcare utilisation, SCT suggests that people are likely to use primary

healthcare services if they think they are vulnerable to health problems and primary healthcare services

are effective in addressing their health problems and if they have the confidence (self-efficacy) to use

these services (Fawcett, & Desanto-Madeya, 2013). In addition, SCT proposes that social and

environmental factors also play a significant role in shaping individuals' health behaviour.

For example, individuals who live in areas with limited access to healthcare services may be less likely

to use primary healthcare services, even if they perceive themselves as vulnerable to health problems.

9
This is because their social and environmental context limits their access to primary health care

services. In contrast, individuals who live in areas with easy access to primary health care services
may be more likely to use these services, even if they do not perceive themselves as particularly

vulnerable to health problems.

Furthermore, SCT maintains that persons are inclined to engage in health-promoting behaviours if

they have role models or social support systems that promote such behaviours (Painter et al., 2008).

This means that if an individual's family or social network encourages the use of primary health care

services, they are more likely to utilise them.

In summary, Social Cognitive Theory proposes that personal characteristics, social and environmental

factors, and cognitive processes influence individuals' behaviour. For example, in the context of

primary healthcare utilisation, as argued by SCT, people are more likely to use primary healthcare

services if they believe they are susceptible to health issues, believe that primary healthcare services

are effective in addressing their health problems, and if they have the confidence (self-efficacy) to use

these services (Whitehead, 2001). Additionally, SCT contends that social and environmental factors,

including access to healthcare services and social support networks, substantially impact how people

behave regarding health-promoting behaviour (Whitehead, 2001).

2.2.3 The Theory of Planned Behavior (TPB)

The utilisation of primary healthcare by elderly women is explained by the theory of Health Belief

Theory postulated by Penchasky and Thomas (1981). This theory states that an individual’s belief

significantly influences health-related behaviour. According to Penchasky and Thomas (1981), the

decision by a person to take a health-related behaviour is based on the following: “If the person is

susceptible to a particular health risk, an assessment of the threat to an individual’s health, whether the

benefit of utilising the healthcare centre outweighs the costs/barriers if they can easily access

10
healthcare without a hitch, and whether there are cues/incentives to remind the person to take a health-

related action. It therefore, means that careful consideration of the abovementioned conditions

determines whether an individual will utilise a primary health centre to resolve a health challengewhen

needed.

An individual’s intentions and conduct are influenced by attitudes, social expectations, and perceived

behavioural control, according to the Theory of Planned Behaviour (TPB), a psychological theory

(Smith et al, 2007). In the context of primary health care utilisation, TPB suggests that an individual’s

intention to use primary health care services is influenced by their attitudes towards these services,

subjective norms or perceived social pressure to use these services, and perceived behavioural control

over using these services.

Attitudes towards primary health care services refer to an individual’s positive or negative evaluation

of these services. According to Conner, et al (2007), TPB, asserts that individuals who have positive

attitudes towards primary health care services are more likely to intend to use them. These positive

attitudes may be influenced by factors such as the perceived effectiveness of primary health care

services, the quality of care provided, and the convenience of accessing these services.

Subjective simply means an individual’s perception of what others think they should do. In the context

of primary healthcare utilisation, subjective norms may be influenced by the beliefs and opinions of

family members, friends, and healthcare providers (Cooke & Sheeran, 2004). TPB suggests that

individuals who perceive that others expect them to use primary health care services are more likely

to intend to use them.

As stated by Fen and Sabaruddin (2008), Perceived behavioural control connotes a person’s

discernment of their ability to use primary health care services. This includes factors such as the cost

of healthcare services, the availability of transportation, and the time required to access these services.
11
TPB suggests that individuals who perceive that they have control over their ability to use primary

health care services are more likely to intend to use them.

Overall, the Theory of Planned Behaviour reveals that a person’s attitudes toward primary health care

services, subjective norms, and perceived behavioural control all have an impact on their desire to use

those services. Therefore, interventions that aim to increase primary health care utilisation could focus

on changing individuals’ attitudes towards these services, providing information on the perceived

benefits of primary health care services, and addressing barriers to access and utilisation. Additionally,

according to (Hagger, et al 2002), interventions could aim to increase social support for primary health

care utilisation and provide resources to improve individuals’ perceived behavioural control over using

these services.

2.2.4 The Andersen Behavioral Model (ABM)

According to “The Andersen Behavioral Model (ABM) identifies three major categories of factors

that influence health care utilisation: predisposing, enabling, and need factors”(Andersen, 1995, p.

3).

Predisposing factors: This refers to an individual’s personal unique qualities that are present in an

individual before a disease develops. Demographics, social structure, health beliefs, and attitudes are

some variables. Predisposing factors may include a person’s age, gender, education level, cultural

background, and opinion of the value of healthcare in the context of primary healthcare consumption

(Andersen, 1995).

Enabling factors: These are tools that can help or hurt people who are using healthcare. These include

private and public resources, including money, insurance, transportation, and the accessibility of

medical treatment. The accessibility of primary care physicians, the location of medical facilities, and

the price of healthcare services are examples of enabling factors in the context of primary healthcare
12
consumption (Andersen, 1995).

Need factors: These factors are related to an individual’s actual or perceived health status. These

factors include acute and chronic illness, functional limitations, and perceived health status. In the
context of primary health care utilisation, need factors might include chronic health conditions,

symptoms that require medical attention, or routine health screenings (Andersen, 1995).

Individuals who are predisposed to use primary health care services may be more likely to seek care

for minor or routine health issues, regardless of their perceived health state, according to the ABM

framework used to explain primary health care utilisation (Bradley, et al., 2004). Therefore, people

who place a high value on preventative care, for instance, may be more likely to go to their primary

care physician for routine checkups and screenings.

Enabling factors play a crucial role in primary health care utilisation because they determine the

availability and accessibility of health care services (Bradley, et al 2004). For example, individuals

who live in areas with limited access to primary care providers or who lack health insurance may be

less likely to utilise primary health care services, even if they need medical care.

Feinberg (2018), opined that need factors are the primary drivers of healthcare utilisation. Individuals

who experience acute or chronic health conditions are more likely to seek medical attention, regardless

of their predisposition to use health care services or the availability of enabling factors. In this way,

need factors often override predisposing and enabling factors in determining primary healthcare

utilisation (Feinberg, 2018).

In summary, the Andersen Behavioral Model offers a thorough framework for comprehending the

intricate interplay between risk, enablement, and need factors that affect the use of primary healthcare

services. Implementing successful interventions requires an understanding of these characteristics to

enhance access to and use of primary health care services.

13
 2.3 Empirical Review

2.3.1 Locality and Utilization of PHC

The utilisation of primary healthcare varies substantially between rural and urban settlers. This could

be attributed to the fact that skilled medical staff and essential equipment are more readily available

and present in metropolitan areas than in rural areas, where more than 60% of the population lives

(Federal Ministry of Health 2020).

The location of healthcare centres and the accessibility of healthcare workers at the centres

significantly impact the utilisation of healthcare centres amongst rural and urban communities.

However, others have placed blame for these allegedly ongoing gaps in the state of the service, a lack

of functioning tools, a lack of infrastructure, poor communication, and a poor access road (Ugal, et

al., 2012).

In Nigeria and elsewhere, distance has been cited as a barrier to the use of PHC services, particularly

in rural regions (Alfaqeeh, et al., 2017). Also, it has been observed that a barrier to obtaining health

services for people living in rural locations is the additional necessity to manage transportation and

its expenses (Wong & Regan, 2009). Community members who thought the medical facilities and

associated services at PHCs were satisfactory will be more likely to use primary healthcare services

than those who thought they were inadequate. However, this factor did not have a big impact

(Alfaqeeh, et al., 2017).

In the private health sector, Ugal, et al. (2012), highlighted that private medical practitioners prefer to

operate in the urban areas where residents earn more and therefore have the ability to pay for the

service, unlike the rural areas where the dwellers are mainly low income earning peasants with little

ability to pay for the service. Furthermore, the relatively insufficient number of skilled and competent

health officers hinders effective healthcare services for individuals in rural and underserved areas that
14
suffer a major percentage of disease compared to their urban counterparts (Ugal, et al., 2012). For

example, the Federal Ministry of Health (2020) found that “as much as 43% of respondents in a study

stated that obstacles to using health care services at both rural and urban facilities included high

transportation costs, high costs for medication and services at the health centre, and lost man-hours”.

A study by Sule et al. (2008) has also blamed the low utilisation of PHC in the rural areas on high cost

of health services in Nigeria. For instance, the researcher found that “about 40% of their respondents

were living in poverty while close to 27% live in extreme poverty” (Sule et al., 2008). Another study

observed that the majority of these individuals are rural dwellers (Abubakar, 2012).

Aside from the issue of the influence of income disparities between rural and urban dwellers on the

utilisation of healthcare, the distance of the health facilities to the patient’s houses poses a significant

challenge to the accessibility of PHC (Adewoye, et al., 2013). Equally, research has shown that

compared to urban residents, rural dweller’s life expectancy is shorter, slum dwellers’ life expectancy

is lower, and infant mortality is higher due to inadequate access to health facilities (Akande, 2013).

However, Riman and Akpan (2012), noted that “although the urban communities have access to health

care services in terms of the road network and availability of personnel, the expense of receiving these

services is a form of constraint to urban dwellers, especially the less fortunate”. A study by Alenoghena

(2019) found that “the utilisation of PHC services for the treatment of common ailments in the

suburban communities was about twice that for the rural communities”. One of the barriers to access

to healthcare is the proximity of the people’s place of residence to the primary health centres leading

to longer travel times to the health centres (Adewoye, et al., 2018). The relative lack of accessto health

facilities has greatly reduced the life expectancy of both rural and “urban slum” dwellers, just as it has

increased infant mortality (Riman & Akpan, 2020). With regard to how income affects the utilisation

of primary health centres, Riman and Akpan (2020), noted that “although the urbancommunities have

access to healthcare services in terms of the road network and availability of personnel, the cost of
15
accessing these services is a form of constraint to urban dwellers, especially theless privileged”.

In order to ensure equity in the distribution of healthcare services in order to reduce morbidity and

mortality, it is crucial to address the disparities in healthcare service utilisation between rural and

urban communities.

2.3.2 Education and Utilization of PHC

Ensor and Cooper (2004), found that a significant number of persons surveyed who did not have

problems paying for health services attained a college education. This postulation, therefore, indicates

that education offers one more chance to be employed and earn legitimate means of paying for a health

service than non-educated persons. Additionally, “educational attainment might be connected with an

improved awareness of sickness, symptoms, and availability of services and its consumption” (Ensor,

& Cooper 2004). It also improves the ability to pay for the numerous costs associated, serving as a

reliable proxy for socioeconomic standing. This result is consistent with past research from Ghana,

Kenya, and Tanzania (Nyamonga, 2002). From the study, half of the participants who easily paid for

their health services were civil servants with health insurance or the means to offset the medical bills.

Ahmed, et al. (2005) found that “level of education and income are positively correlated with

utilisation of healthcare services, adding that unequal access to primary healthcare is mainly due to

inequalities in socioeconomic status”.

2.3.3 Income and Utilisation of PHC

Some studies have shown a wide disparity in access to healthcare between high socioeconomic class

and those of low socioeconomic status, with the low-income earners more likely to patronise the patent

medical dealers and the herbalists where treatments are perceived to be inexpensive (Ewelukwa, et al.,

2013). For example, Onwujekwe, et al. (2011), conducted a study in South-East Nigeria and found

that the high cost of health services prevented about 35.5% of the participants from accessing the
16
primary health care centre. Similarly, in Zambia, Phiri and Ataguba (2014) reported a “statistically

significant negative concentration indices for all public facility visits for the poor while the

concentration index of the rich for public hospital visits is positive and statistically significant at the

5% level”.

In the United States of America, income is a determinant of access to health facilities, as many studies

indicate that higher-income earners have more access to healthcare than lower-income earners. For

instance, “in 2009–2010, people of all racial and ethnic groups who were 18–64 years old and had a

family income below 200 per cent of the poverty threshold were more likely than those who had a

higher family income to delay seeking or fail to obtain essential medical treatment because of cost”

(NCHS, 2016). Failure to access medical facilities was more pronounced amongst families who live

below the poverty level and those whose income was between 100-190% poverty level (NCHS, 2016).

Further, Ahmed, et al. (2005), argued that the income level of the elderly is a strong predictor of health-

seeking behaviour, just as the level of education of female elderly persons also has a way of influencing

their method of treatment as well as the likelihood for them to purchase drugs from

untrained/unlicensed medical personnel.

2.3.4 Other Socio-economic Factors

According to Nwokoro et al. (2022), in their report, asides from the issue of the high cost of service in

PHCs, the main reasons for the non-use of PHCs are low-quality healthcare, inadequate medical

personnel, and waiting for a long time before being attended to. Likewise, in another study by Ige, and

Nwachukwu (2010) in the South Eastern part of Nigeria, long waiting period and inadequate medical

personnel at the PHCs are the leading factors preventing elderly persons from accessing healthcare,

just as it inhibits both maternal and child health care at the PHC level. Ige and Nwachukwu (2010),

further reported that “patient waiting time and availability of necessary drugs as major determinants

17
of patient’s satisfaction with primary healthcare services.”

Ige, and Nwachukwu (2010), equally revealed that “socio-demographic characteristics such as age

category, educational level, occupational position and having a child less than five years in a

respondent´s household was not substantially linked with the usage of primary health care services”.

Meanwhile, their research indicated that gender played a significant role in using PHC. They found

that elderly women had an 80% higher likelihood of using primary health centres than their male

counterparts (Ige, & Nwachukwu 2010). This finding is contrary to the common belief that women

will use less PHC due to some traditional beliefs obtainable in developing nations where social and

cultural beliefs hinder women from making independent decisions, like deciding to visit a healthcare

centre without consulting their male spouses. However, a possible reason for the higher rate of

women’s healthcare utilisation in the above research is due to the services provided in the research

setting by the PHC, such as family planning, maternal and child health services, and immunisation

programmes. All these programmes are likely why women reported higher utilisation of PHC than

men. Similarly, in their research, Vaidya, et al. (2012), found that “women have higher health service

utilisation than males due to gender variations in morbidity patterns and because women are more

likely to disclose their health concerns or use preventative health services than men”.

18
 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction

This section describes the techniques and methods used to conduct the study in terms of data gathering

and interpretations. Research requires meticulousness and exactness. It is, therefore, necessary to apply

the right techniques to gather data; otherwise, it renders whatever outcome invalid. Kothari (2004),

supported this assertion when he opined that a good research methodology must possess three

components: the first category must include techniques for gathering data, the second category must

include methods for determining relationships between the data and the unknowns, and the third

category must include techniques for assessing the accuracy of the results.

3.1 Research Design

The research design is one of the most important parts of a research methodology. This assertion was

demonstrated by Babbie (2018, p. 30), who stated that the number and type of observations that will

be made as a foundation for conclusions might occasionally be predetermined by the research strategy.

A good design should, therefore, inform a reader of the type of data to be generated even ahead of the

research itself. As opined by Kothari (2014), what constitutes a research design are decisions with

respect to “what”, “where”, “when,” “who”, “how much”, and “by what means” concerning a particular

study(p. 15). He therefore, defined research design as the arrangement of conditions for the collection

and analysis of data in a manner that aims to combine relevance to the research purpose with a detailed

procedure.

The researcher adopted the Key Informant Interview (KII) technique to elicit responses from patients,

core clinical health workers (doctors, nurses and medical social workers), ancillary health workers such

as community health extension workers and other experts who are considered knowledgeable in the area
19
of primary healthcare delivery. The choice of an interview in the study was because the elderly persons,

who may constitute the majority of the research participants, may not be able to read or write therefore

limiting their ability to respond sufficiently to a questionnaire. Also, interviews offered better

opportunities for the researcher to probe more into the phenomenon under investigation in order to

adequately answer the research questions. This made the findings more robust. Hence, the questionnaire

was not used to gather data as the research was strictly a qualitative study wherein information was

elicited from the respondents through Key Informant Interviews (KII) of the health professionals and In-

depth Interviews (IDI) of the patients.

3.2 Study Location

The location of this research includes some selected Primary Health Centres in the Yaba area of Lagos

Metropolis. These PHCs include: Iwaya PHC, located at 27/27 Omotola Str, Iwaya, Yaba, with

coordinates; Oba Salami PHC, located at 14, Onayade Street, Igbobi Sanbe, Jibowu, Fadeyi;Alhaji Kola

Osho PHC, located at 3, Eletu Odibo Street, Abule Oja; and Aiyetoro PHC at 1, Wright Street,

Adekunle, Under ‘Okobaba Overhead Bridge Behind Better Life Market’. Attached are the pictures

and Google map locations of the above-mentioned venues:

20
Figure 1: Pictorial representation of Iwaya PHC, Yaba, LGA, Lagos State

Figure 2: Google map Representation of Iwaya PHC (Coordinates = 6.50747, 3.39327)

21
Figure 3: Pictorial Representation of Oba Salami Health Centre, Yaba, LGA, Lagos State

Figure 4: Google Map Representation of Oba Salami PHC (Coordinates = 6.52331, 3.36951)

22
Figure 5: Pictorial Representation of Alhaji Kola Osho PHC

Figure 6: Google Map Representation of Alhaji Kola Osho PHC (Coordinates = 6.5211212,

3.3810694).
23
Figure 7: Pictorial Representation of Aiyetoro PHC

Figure 8: Google Map Representation of Aiyetoro PHC (Coordinates = 6.52824, 3.38848)

24
 3.3 Population of the Study

According to Babbie (2018, p.29), the collection of components from which the sample is actually drawn

is known as the study population. The study population of the study comprised all female elderly patients

and core health clinic workers in PHCs within Lagos State. For the current research, the information

obtained from these target populations was applied to ascertain how socioeconomic variables influence

the utilisation of PHC in the Lagos metropolis.

3.4 Sample Size

Soyombo (2001), defined sample size as a smaller representation of a larger population. He noted that if

it is practically possible, it would be better to study the entire population, as it would increase the

confidence level of the study. However, in reality, it is impracticable because not all responders may

be reachable, or the researcher may lack the means to do so (Soyombo, 2001, p.84).

Thus, forty (40) respondents comprising 20 female elderly patients and 20 hospital staff, were selected

and interviewed by the researcher.

Samples for qualitative studies are generally much smaller than those used in quantitative studies.

Ritchie, Lewis and Elam (2003), provide reasons for this. There is a point of diminishing return to a

qualitative sample as the study goes on more data does not necessarily lead to more information. Hence,

the authors noted that in qualitative research, the concept of sample size is often approached differently

compared to quantitative research. Qualitative research focuses on understanding and interpreting the

meaning and experiences of individuals, rather than on statistical generalisation (Ritchie, Lewis and

Elam, 2003, p. 78). However, according to Morse (1994, p.225), the idea of "saturation" is commonly

used in qualitative research to determine when enough data has been collected. As a result, sample size

calculations in the traditional quantitative sense are not typically a requirement for qualitative studies. A

review of past literature provides some guidelines for sample size in different forms of qualitative

25
research. For instance, for ethnography and ethnoscience studies, Morse (1994, p.225) recommends a

sample size of between 30-50 for both, while Bernard (2000, p.178) opined that “most studies are based

on samples between 30-60 for ethnoscience”. For grounded theory methodology, Creswell (1998, p.64)

“suggested a sample size of 20-30”. Similarly, for phenomenology, Creswell (1998, p.64) “recommends

a sample size of 25” while Morse (1994, p.225) suggests at least six. Lastly, Bertaux (1981, p.35)

suggested that “for all qualitative research, a sample size of fifteen should be the smallest acceptable

sample.” The current study therefore wishes to align itself with Morse (1994, p.225), who suggested a

sample size of between 30 and 50 by interviewing a sample of 40 participants. It is believed that

interviewing participants in the range of this number was sufficient to obtain quality information to

answer the research questions.

3.5 Sampling Technique

According to Olakunori (2000, p. 55), a sampling technique is a strategy researchers use to create a

sample that accurately represents the population being studied. This study adopted the convenience

sampling technique to sample the respondents. Therefore, the researcher approached the four (4) PHCs

in Yaba, LGA of Lagos and requested their consent to participate in the research. The targeted sample

size for the study is forty (40) persons, including elderly patients and hospital staff was actualised at the

end of the study.

3.6 Sources of Data

The present study gathered data with the help of both primary and secondary data sources. These two

sources of data aided the researcher in the process of answering the research questions in order to make

appropriate deductions.

26
 3.6.1 Primary Data

The primary data were obtained by interviewing twenty (20) participants who are elderly female patients

as well as twenty (20) staff of the above-listed PHCs in Yaba LGA of Lagos State. The semi-structured

interview questions were administered at the hospitals on the interview dates agreed with the

management of the different institutions. The interview questions were explicitly targeted at the female

elderly patients of the hospital and both male and female hospital staff who are believed to possess

adequate knowledge of the subject matter. The study interviewed 5 hospital staff and 5 elderly female

patients from each of the 4 primary health centers. Twenty-six (26) semi-structured interview questions

designed by the researcher elicited responses from the interviewees after careful consideration of face

and content validity. Semi-structured interviews are similar to structured interviews in that the questions

that the respondents were asked were carefully formulated before the session. According to Boyatzis,

(2016, p. 19), when the researcher wants to gather data on people's views and opinions about a given

phenomenon on a large scale or when the researcher is not well-versed in available practices about a

phenomenon, the semi-structured interview is preferable because it uses open-ended questions to elicit

varying response from participants. This interview style was chosen because it enabled the researcher to

deeply comprehend the respondents’ opinions on the socioeconomic determinants of the utilisation of

primary healthcare. It also allowed the researcher to scrutinise the gaps between the realities in terms of

the association between the independent and dependent variables compared to the available literature.

Nevertheless, a significant limitation of this approach is that analysing interview data from an open-

ended questionnaire is often more difficult than data from closed-ended questions. This is attributable to

the fact that sometimes, it is difficult to analyse in specific terms the pattern of responses of a respondent.

In addition, because of the difficulty in maintaining rapport in an interview session, and to ensure quality

of response, the study decided to trim the number of interviewees to only forty (40). This will greatly

enhance the quality and reliability of interview data. On the dates of the study, which lasted for eleven
27
(11) days due to difficulty in getting the proposed sample size, the researcher interviewed the participants

in the company of her research assistant, who was trained for this purpose. While the researcher asked

the questions, the research assistant recorded the summary of interview responses, that were

subsequently subjected to thematic analysis in order to answer the research questions.

3.6.2 Secondary Data

The secondary sources of data were obtained from other sources like journal articles, and textbooks

from the already existing literature on PHC.

3.6.3 Instrument for Data Collection

The researcher drafted a list of interview questions which she submitted to her supervisor for scrutiny

to establish content, face and construct validity. This process was to ensure that the instrument is good

enough to elicit the expected response capable of answering the research questions.

3.7 Procedure

Before conducting the interview, the researcher visited the above-mentioned Primary Health Centres

in the Yaba area of Lagos State to get permission from the Medical Officer of Health, who oversees

the operations of the Primary Health Centres in the Yaba Local Council Development Area, to enable

her to interview its staff and some of the patients for research purposes. Because of the nature of the

research, the interviews lasted for eleven (11) days as the researcher visited the hospitals on several

dates in order to reach out to more respondents. During the interview sessions, the researcher

encouraged the participants to respond freely to the questions as it was strictly for research purposes.

She was also assisted by a research assistant who helped her to record responses during the interview

sessions. The research assistant, who is a final year undergraduate student from the Department of

Psychology, University of Lagos, underwent a day of training on the objectives of the study, as well

28
as her role/expectation during the course of the interview. It is believed that considering her year of

study and academic experience, she was well acquainted with the basic rudiments of research and was

therefore helpful in recording the interview sessions as well as rendering other assistance in the process

of the research as situations may require. Attached herewith are copies of ethical approval and a letter

of permission to conduct the research.

29
Figure 1: Letter of approval from the Medical Officer of Health, Yaba Local Council
DevelopmentArea.
30
Figure 2: Letter of approval from the Medical Officer of Health, Yaba Local Council
DevelopmentArea.

31
3.8 Method of Data Presentation/Analysis

The thematic analytical method was used to organise, analyse, and present the findings of the study.

According to Boyatzis (1998, p. 19), thematic analysis, which involves looking at a set of qualitative

data to find common themes, ideas, or patterns of meaning shared by all respondents' responses, is a

method of identifying, analysing, and reporting data patterns and further interpreting various aspects of

the research questions. This technique is applied if the researcher is interested in knowing people’s

opinions and experiences on a particular subject matter (Jack, 2019, p.12). Applying this technique

enabled the researcher to study response patterns among the participants to highlight common patterns

among them. The themes chosen for the examination have a strong connection to the data (Patton, 2015,

p.157). They were adjudged to reasonably represent the data set based on their consistency throughout

the data and significance to the study objectives. The data gathered from the interview were therefore

subjected to thematic analysis using Nvivo app which helped to easily locate participant’s opinions on

some questions from the interview transcripts after carefully identifying nodes/themes to answer the

research questions.

32
 CHAPTER FOUR

RESULTS AND DISCUSSION OF FINDINGS

4.0 Introduction

This chapter presented the results of the thematic analysis as computed by the Nvivo statistical package.

The main findings of the research were therefore outlined in the current chapter, while discussions on

the findings were done after the outlined results had been presented. The chapter therefore conducted

thematic analysis on the recorded interview sessions from different participants. The analysis generated

themes for the five itemized hypotheses of the current study.

By applying in-depth thematic analysis on the data, the research was able to uncover how socioeconomic

status influences the utilisation of Primary Health Centres amongst elderly women in the Lagos

metropolis. The themes from the thematic analysis were supported with direct quotes from the

interviewees. Table one comprises the interviewee lists description with their corresponding codes.

Respondent Status Code Number of % of the total

Participants sample

Doctors D1 - D10 10 25%

Nurses N1 - N10 10 25%
PATIENTS P1 - P20 20 50%
TOTAL 40 100%

33
Table 1: List of Respondents and their Codes

Source: Researcher, 2023.

Themes Number of mentions

Research Question 1: Socioeconomic Status and Utilisation of PHC
Theme 1: Financial Constraints 23
Theme 2: Education and health literacy 18
Theme 3: Family Support 7
Theme 4: Health Insurance Cover 6

Research Question 2: Education and utilisation of PHC

Theme 1: Understanding and confidence 6
Theme 2: Personal Experiences and Cultural Belief 8
Theme 3: Effective Communication 4
Research Question 3: Area of Residence and utilisation of PHC
Theme 1: geographical barriers. 16
Theme 2: socioeconomic factors 3
Theme 3: Community Support/Social Factors 8
Theme 4: Healthcare Infrastructure Awareness
10
Research Question 4: Poor PHC and utilization of facility
Theme 1: Quality healthcare facility 7
Theme 2: Accessibility and availability 6
Theme 3: Inadequate Personnel 8
Research Question 5: Use of Traditional Medicine and Utilization of PHC
Theme 1: Cultural influences 9
Theme 2: Accessibility, affordability 13
Theme 3: Delayed utilization 03
Theme 4: Lack of health education 6
Table 2: Narrative analysis of key themes
Source: Researcher

Research Question One:

Will socioeconomic status play a role in the utilisation of primary healthcare amongst elderly women in

Lagos Metropolis?

34
The interview responses provided valuable insights into the role of socioeconomic status in the utilisation

of primary healthcare services among elderly women in Lagos Metropolis. through the help of the Nvivo

app, several key themes emerged based on the responses from the participants. The identified themes for

this research question are summarised in the figure below:

Figure 1: Identified themes for the impact of socioeconomic status on utilization of PHC amongst elderly
female.
Source: Researcher, 2023.

Theme one: Financial Constraints

Several interviewees emphasised the role of financial constraints as a significant factor affecting the

utilisation of primary healthcare services among elderly women in Lagos Metropolis. Both healthcare

providers, caregivers and elderly patients noted that limited income and the inability to afford healthcare

expenses, such as transportation, medications, and private healthcare, posed substantial barriers to

accessing care. As noted by one of the elderly patients in her response:

35
“I believe that economic status plays a significant role in whether rural and urban dwellers visit Primary

Health Care (PHC) facilities when facing health issues. In urban areas, there are usually more

accessible healthcare options, but they can be costly. For people with a higher economic status, it is

easier to afford these services and access them promptly. However, in rural areas, the options may be

limited, and even if PHCs are available, some individuals might struggle to afford transportation or

medical fees, which can deter them from seeking healthcare”. Also, one elderly, patient, who claimed to

have witnessed first-hand experience of how lack of money delays elderly women’s access to PHCs has

this to say about her experience before his son brought him to Lagos from the South-East:

“I lived in a very remote area, and I can tell you that economic status makes a big difference. In my

village, many people, including myself, face financial constraints. When you are struggling to make ends

meet, the thought of spending money on healthcare can be daunting. We often delay seeking help until

the condition worsens because we are worried about the costs involved”

Theme two: Education and health literacy

The second theme that emerged was the influence of education and health literacy on healthcare

utilisation. Interviewees highlighted that elderly women with higher levels of education were more likely

to understand the importance of regular check-ups and preventive care. This increased health literacy

allowed them to assess the primary healthcare system more effectively, in contrast to those with limited

education who faced additional barriers in accessing care. This view was in tandem with the expert view

of one of the doctors who answered thus:

“While economic status can influence healthcare decisions in urban areas, it is not the sole determinant.

In cities, there are often more job opportunities that can mitigate financial barriers. However, factors

like education, awareness, and cultural beliefs also play a role in determining whether someone seeks

healthcare, regardless of their economic status”.

36
Theme three: Family Support

Furthermore, analysis indicates that Family support is another crucial socioeconomic factor influencing

the utilisation of primary healthcare amongst elderly women in the Lagos metropolis. Elderly women

who had strong family support systems were more likely to access healthcare services. Equally,

caregivers/health workers mentioned that emotional and financial assistance from family members

played a pivotal role in encouraging elderly women to prioritize their health. In contrast, those lacking

family support were more vulnerable to neglecting their healthcare needs. As stated by one of the

interviewees, without adequate support from children and their extended family, the ability to access

healthcare would be very difficult. Hence, she stated that:

“As a doctor that have treated lots of elderly patients, I have observed that family support is crucial.

Many elderly women rely on their families for emotional and financial assistance. When they have

supportive family structures, it is easier for them to access healthcare. However, those who lack family

support may struggle to prioritise their health due to loneliness and financial constraints”.

Theme four: Access to Health Insurance

The availability of health insurance coverage was identified as a significant socioeconomic factor

influencing the use of Primary health centres amongst elderly persons. Interviewees noted that elderly

women with health insurance were less likely to utilize primary healthcare services. This is because

health insurance helped alleviate the financial burden of medical expenses, making it easier for them to

seek regular check-ups and treatment from healthcare providers other than the PHCs. Conversely, those

without insurance are more inclined to visit the PHCs due to the high financial burden of accessing

private health facilities. An example of a narrative from one of the respondents indicates thus:

“Well, I think socioeconomic status plays a significant role. If you have a stable income and access to

health insurance, you are less likely to use primary healthcare services regularly. However, for those of

us on a fixed pension or without adequate financial support, it can be challenging. Many elderly women

37
in Lagos like me might skip check-ups or delay treatment due to financial constraints”. Relatedly, a

doctor in one of the PHCs noted that:

“From a policy perspective, addressing the influence of socioeconomic status on healthcare utilisation

among elderly women in Lagos is crucial. We need to work towards a more inclusive healthcare system

that considers the financial constraints faced by lower-income individuals. This might involve expanding

insurance coverage, and improving the accessibility of primary healthcare services to ensure that all

elderly women can access the care they need”.

In summary, these themes collectively suggest that socioeconomic status indeed plays a substantial role

in the utilisation of primary healthcare services among elderly women in Lagos Metropolis. Financial

constraints, education and health literacy, family support, and health insurance coverage are key factors

that influence whether elderly women utilise primary healthcare services. Addressing these factors

through targeted interventions and policy measures is essential to improve healthcare equity for this

vulnerable population.

Research Question Two:

Will the level of education influence the utilisation of primary healthcare amongst elderly women in

Lagos Metropolis?

In answering the above research questions, thematic analysis of the interview responses suggests that the

level of education can influence an elderly woman’s belief in the ability of Primary Health Care (PHC)

to treat her when faced with health challenges among residents of Lagos Metropolis. Three key themes

emerge from the responses, as indicated in the figure below:

38
Figure 2: Diagrammatic representations of the identified themes for Research Question 2

Source: The Researcher, 2023.

Theme One: Understanding and Confidence

Respondents highlighted that education can significantly shape an individual’s understanding of

healthcare and increase confidence in PHC. They emphasised that education provides them with the

knowledge and critical thinking skills to navigate the healthcare system effectively. They therefore

opined that educated elderly women may be more inclined to trust and utilise PHC due to their deeper

understanding of modern medical treatments over traditional medicine. For instance, one of the elderly

patients who holds a National Certificate in Education (NCE) has this to say:

“From my perspective, educational attainment can indeed influence an elderly woman’s belief in PHC.

With an NCE, I have a deeper understanding of the role of modern medicine in promoting healthcare. I

have confidence in this Primary Health Care facility because I can navigate the healthcare system more

effectively. However, I think there is a need for the government must ensure that even those with limited

39
education can access and trust PHC services through increased awareness in remote areas because

education should not be a barrier to receiving proper healthcare”.

Personal Experiences and Cultural Beliefs

There were also indications from the data set that beyond education, the issue of elderly women’s past

personal experience and cultural beliefs play a moderating factor in their ability to utilise PHCs

irrespective of their level of education. For instance, while some of them with higher education noted

that they do not have much trust in the PHCs due to their ugly experiences in the past, where they lost

someone in the PHC due to perceived negligence, some of them without University education indicated

better trust in the PHCs describing it as a lifesaver, especially for poor persons with no resources to

access better care in private hospitals. In line with this, one elderly patient answered that:

“I think education plays a role, although I believe there are other determinants of an elderly woman's

belief in PHC. While I have higher education, I have also witnessed where personal experiences and

cultural beliefs had strongly influence one's view and use of the Primary Health Centre”.

The above responses, therefore, suggest that trust in PHC can be influenced by factors beyond education.

Theme Three: Accessibility and Effective Communication

Accessibility and ability to communicate effectively, which are both advantages of being educated, were

identified by the health professionals as some of the factors that endear elderly women to the PHCs.

They argue that while education can enhance understanding and trust, healthcare providers must ensure

that information is presented in a clear and simple manner, bridging knowledge gaps. While education

aids quick comprehension of issues around the effective use of PHCs, some of the doctors interviewed

suggested massive campaigns in the rural areas, using their local languages on the need for more

patronage of the PHCs by elderly persons. This, according to them, will build confidence in the primary

40
healthcare institutions across the Lagos metropolis, especially amongst the less educated ones who may

have a preference for local traditional medicine.

In summary, with regard to the second research question, the thematic analysis indicates that the level of

education can influence elderly women’s belief in PHC among residents of Lagos Metropolis. As

education can enhance understanding and confidence in PHC, personal experiences, cultural beliefs, and

effective communication also play significant roles which are all benefits of education play a role in

utilization of PHC amongst elderly women. To promote the utilization of PHC among elderly women, it

is essential to consider these factors and ensure healthcare accessibility and clarity of information for all.

Research Question Three

Does participant’s area of residence have a significant influence on the utilisation of primary healthcare

amongst elderly women in Lagos Metropolis?

Thematic analysis of the interview responses suggests that the participant's area of residence indeed

influences the utilisation of Primary Health Centres (PHC) services amongst elderly women in Lagos

Metropolis. Four key themes emerged from the responses, as represented in the diagram below:

41
Figure 3: Diagrammatical representation of the identified themes for research question three

Source: The researcher, 2023

Theme One: Geographical Barriers

Participants noted that barriers such as the distance of elderly people’s residence to the PHCs pose serious

challenges to their utilisation by them. Interviewed patients consistently highlighted that distance to

healthcare facilities is a substantial barrier, especially for elderly women in rural areas. In rural settings,

healthcare facilities are often far away, leading to delayed or forgone healthcare visits. In contrast, elderly

women in urban areas, such as Lagos generally have better access to healthcare facilities, reducing the

barrier posed by distance. One of the interviewed nurses, amongst others, has this to say:

“Well, from my experience working in a rural healthcare setting, I can say that distance to health centres

is a significant barrier for many people. Patients often complain about the long distances they have to

travel to access primary healthcare services. This is especially true for those living in remote areas

42
where the nearest health centre can be hours away. It not only discourages regular check-ups but also

delays seeking medical attention when needed”. Similarly, a patient reacting to interview questions that

have to do with distance to health facilities has this to say: “I believe that the lack of community linkage

roads and long distances can significantly impact elderly women's access to primary healthcare services,

especially for those in rural areas. As we age, mobility becomes a challenge, and without proper roads

or public transportation options, it becomes difficult to reach healthcare facilities. Many of us rely on

walking or public transportation, and if the roads are inaccessible or distant, it becomes a barrier to

seeking medical attention when needed. This can lead to delayed access to healthcare, which is

detrimental to our well-being”.

Theme Two: Socioeconomic Factors

Socioeconomic factors such as income disparities and lack of efficient transportation systems especially

in remote areas were identified as some of the socioeconomic factors relating to how a patient’s area of

residence can affect her utilisation of PHC. Respondents opined that low-income neighbourhoods face

challenges in accessing and utilising PHC services. By implication, economic constraints can prevent

elderly women in both urban and rural areas from affording healthcare services, irrespective of their

proximity. On the other hand, the availability and accessibility of transportation options were mentioned

as crucial factors. Lack of good community linkage roads, and high cost of transportation fare especially

in rural areas, hinders elderly women’s mobility and access to healthcare services according to some

respondents. Similarly, one of the interviewed patients has this to say: I think that lack of good roads

and long distances can significantly impact elderly women's access to primary healthcare services,

especially in rural areas”.

43
Theme Three: Community Support and Social Factors

Furthermore, with regard to patient’s place of residence and their ability to access PHC, participants

noted that urban areas have stronger community support networks, which facilitate access to healthcare

services for elderly women. In contrast, rural areas may lack such support systems, making it more

challenging for elderly women to navigate the healthcare system. This is to say that it is possible that

more persons in the urban areas will be more open to advising or even helping an elderly woman to

access medical care, unlike those in the rural areas whose support system may refer them to traditional

medical practitioners. Additionally, cultural beliefs and stigma were highlighted by some of the

participants as some social factors that may play a role in elderly people’s access to PHC, primarily

because of the information available to them because of where they reside. This is because, as stated by

some patients, fear of judgment or adherence to traditional beliefs can deter them from seeking PHC

services, especially for those who live in underserved areas. For instance, one of the doctors has this to

say:

“I believe cultural beliefs and stigma can play a significant role. Some elderly women in rural areas

might avoid seeking PHC due to traditional beliefs or fear of being judged by community members”.

Also, one patient reacting to the issue of how social support in rural areas affects the utilisation of

healthcare in those areas has this to say: “Elderly women in rural areas may face lack of social support

in seeking healthcare as their social unit are made up of locals who advise them to resort to the use of

herbs by traditional medicine merchants, which can affect their willingness to seek PHC”.

Theme Four: Health Infrastructure and Awareness

Participants, especially the health professional, highlighted the limited number of healthcare practitioners

in the rural areas as one of the reasons why patients do not patronize PHCs in those areas. They stated

that rural areas tend to have limited healthcare infrastructure, leading to difficulties in accessing PHC

44
services. Also, health literacy in some areas affects elderly people’s utilisation of PHCs, as explained by

health officers who were interviewed. A lack of health literacy was identified as a factor influencing both

urban and rural elderly women's utilization of PHC services. Limited awareness of available services

and healthcare needs can therefore hinder the proactive healthcare-seeking behaviour of elderly persons,

especially in rural areas. One of the respondents had this to say:

“I want to emphasise health literacy. In rural areas especially, elderly women might not have sufficient

knowledge about their healthcare needs or the available services. There is a need for more health

education and awareness campaigns tailored to their needs, especially in rural areas”.

Research Question Four

Will the poor primary healthcare facility be a significant predictor of utilisation of primary healthcare

amongst elderly women in Lagos Metropolis?

Thematic analysis of the interview responses revealed three robust themes that shed light on whether

poor primary healthcare facilities serve as a significant predictor of utilisation of primary healthcare

among elderly women in Lagos Metropolis. Participants also suggested two major ways in which PHC

facilities can be improved to ensure enhanced service delivery to the people in the area. The three themes

are illustrated in the figure below:

45
Figure 4: Illustration of the themes for research question four

Source: The Researcher, 2023

Theme one: Quality Healthcare Facility

Respondents consistently emphasised that the quality and condition of primary healthcare facilities have

a direct impact on the utilisation of these services by elderly women. Poorly maintained or inadequately

equipped facilities deter them from seeking care, while well-maintained centres attract them. Hence, one

of the patients stated thus:

“I have noticed that when health facilities are readily available and offer good quality service, it

encourages me to seek care promptly. If it's too far or the services are poor, I always procrastinate

visiting the hospital, which is not good for my health at this age.

Theme two: Accessibility and availability of quality PHC facility

The availability of healthcare facilities and proximity to elderly women's homes are significant factors.

They indicated that the quality of the facility would not mean much if it were not readily accessible to

them. Therefore, elderly women are more likely to use PHCs if they are easily accessible and not too far
46
away. Inadequate availability discourages utilisation. In line with this theme, one of the interviewed

elderly women has this to say:

“The availability of health facilities is a big factor as it is as important as the quality of the facility. When

a PHC is close to my home, I am more inclined to use it. Quality is equally important; if the services are

professional and respectful, I will have confidence in the care I receive, which makes me more likely to

visit when I feel sick”.

Theme Three: Inadequate Personnel

Inadequate personnel in the health centres were also identified as a major barrier to accessing primary

healthcare by elderly women. Elderly women sometimes face long waiting times, due to a shortage of

healthcare staff, which discourages them from seeking care. One of the respondents answered:

“Inadequate health centres and personnel play an important role in discouraging elderly women from

accessing primary healthcare services (PHC). From my experience, when elderly women perceive that

there are not enough healthcare facilities or personnel to meet their needs, they often hesitate to seek

care. They may fear long wait times or the unavailability of necessary treatments. So, these inadequacies

can have a substantial impact on their willingness to access PHC”. In addition to the issue of how the

status of PHC facilities affects elderly women’s utilisation of PHC, the respondents identified several

solutions to the problem of poor facilities as it affects the utilisation of PHCs amongst the elderly. As

such, the respondents suggested both short-term and long-term solutions to building quality Primary

Health Centres. Hence, a Public-private partnership was suggested to provide short-term relief by

increasing the number of available health centres and personnel. However, there is a consensus that the

government plays a crucial role in addressing the long-term issue of inadequate healthcare facilities and

personnel through investment in infrastructure, education, and healthcare workforce. For instance, one

of the doctors asserted that “an immediate solution to the problem of inadequate health centres and

47
personnel in Lagos Metropolis could involve establishing mobile health clinics or outreach programs to

bring healthcare services directly to communities in need. Additionally, partnering with private

healthcare providers could help bridge the gap in the short term. For the long term, government

investment in infrastructure and education to train more healthcare professionals is crucial to ensure

sustainable healthcare access”.

In summary, based on the above themes, it is evident that poor primary healthcare facility quality and

availability are significant predictors of utilisation among elderly women in Lagos Metropolis. The

quality of facilities and the presence of well-trained personnel directly influence whether elderly women

seek primary healthcare services.

Research Question Five

Will access to traditional medicine influence the utilisation of primary health care amongst elderly

women in the Lagos metropolis?

Thematic analysis showed that access to traditional medicine truly influences the utilisation of primary

healthcare among elderly women in Lagos Metropolis. Most of them explained that patronage of

traditional medicine could have significant implications for the overall health outcomes of elderly

women, including delayed diagnoses, missed opportunities for preventive care, and the potential

exacerbation of health problems. Four themes were identified, including Cultural influences,

accessibility and affordability, delayed utilization, and lack of health education. These themes are

illustrated in the diagram below:

48
Figure 5: Illustration of the themes for the fifth research question

Source: Researcher

Theme One: Cultural influences

Respondents consistently mentioned that the preference for traditional medicine among elderly women

in Lagos Metropolis is influenced by cultural beliefs and trust in traditional healing methods. Traditional

medicine is seen as culturally familiar, leading to a strong preference for it over primary healthcare

services. The comfort of dealing with traditional healers from their own communities and shared cultural

backgrounds contributes to this preference. One of the nurses answered thus:

“In my research, I've found that elderly women in Lagos Metropolis often have access to a wide range

of traditional medicine practitioners. These practitioners are deeply embedded in the local culture and

communities. Some elderly women prefer traditional medicine due to its familiarity and cultural

relevance. This preference can impact their utilisation of primary healthcare services, as they may only

seek medical care when traditional methods prove ineffective”.

49
Theme Two: Accessibility and Affordability

Most patients noted that many elderly patients patronize traditional medicine because of its affordability

and easy access. Access to traditional medicine is often easier, more convenient, and cost-effective for

elderly women in Lagos Metropolis. Some elderly women may choose traditional medicine due to

limited financial resources or mobility issues, making it an easy alternative. The convenience of having

traditional healers within their communities plays a significant role in their decision-making process

delayed utilization, and a lack of health education. A doctor has this to say:

“In Lagos Metropolis, the availability of traditional medicine practitioners is quite prevalent. Elderly

women often have easy access to these services within their communities. This situation sometimes leads

to a partial reliance on traditional medicine and reduced utilisation of primary healthcare services,

particularly for preventive care”.

Theme Three: Delayed Utilisation

The preference for traditional medicine can lead to delayed visits to primary healthcare services. Elderly

women often turn to traditional remedies first, hoping for quick solutions. This delay in seeking formal

healthcare can result in missed opportunities for early diagnosis and timely intervention and a lack of

health education. A doctor in one of the hospitals has this to say:

“I have witnessed that access to traditional medicine can sometimes discourage elderly women in Lagos

Metropolis from seeking primary healthcare services. They may have trust in traditional healers and opt

for their services first, especially for chronic or age-related ailments. To promote better utilisation of

primary healthcare, it is essential to create awareness about the benefits of early diagnosis and

professional medical care, even alongside traditional practices”.

50
Theme Four: Lack of health education

Analysis of the responses also revealed that underutilisation of primary healthcare services is often due

to the preference for traditional medicine, occasioned by inadequate health education of residents. This

can have negative implications for the overall health outcomes of elderly women. Delayed diagnosis,

fragmented care, and missed preventive measures can lead to worsening health conditions. The lack of

continuity in healthcare services and limited health education can contribute to poorer health outcomes

in the long term. A patient has this to say on whether access to traditional medicine influences

participants’ health-seeking behaviour in the PHCs:

“I have seen that the availability of traditional medicine often influences people's initial decision-making

when they fall ill. They may opt for traditional treatments first due to a lack of health education. This

can sometimes lead to slow healthcare outcomes if their condition requires professional medical

attention”.

In summary, it is obvious from the results that access to traditional medicine in the Lagos Metropolis

influences the utilization of primary healthcare services among elderly women. Cultural factors,

accessibility, affordability, and lack of health education play a pivotal role in shaping their healthcare

decisions. These factors, in turn, have significant implications for their overall health outcomes.

4.1 Discussion of Findings

The study investigated socio-economic factors influencing elderly women's utilisation of primary

healthcare services in the Yaba Local Council Development Area, Lagos state. Five research questions

were considered. They include: will socioeconomic status play a role in the utilisation of primary

healthcare amongst elderly women in Lagos Metropolis? Will the level of education influence the

utilisation of primary healthcare amongst elderly women in Lagos Metropolis? Does the respondent’s

area of residence have a significant influence on the utilisation of primary healthcare amongst elderly

women in Lagos Metropolis? Will poor primary healthcare facilities be a significant predictor of

51
utilisation of primary healthcare amongst elderly women in the Lagos Metropolis? Will access to

traditional medicine influence the utilisation of primary health care amongst elderly women in the Lagos

metropolis?

In answering the first research question, the study found that socioeconomic status, indeed plays a role

in the utilisation of primary health centers amongst elderly women in the Lagos metropolis. Financial

constraints, education and health literacy, family support, and health insurance coverage are key

socioeconomic determinants of whether elderly women can access and benefit from primary healthcare

services. In line with this finding, Newbrander et al. (2020), noted that the socio-economic environment

in which most PHC facilities operate has been established as a significant factor in their performance

and patronage. Also, Onwujekwe, et al. (2011), conducted a study in South-East Nigeria and found that

the high cost of health services prevented about 35.5% of the participants from accessing the Primary

Health Centre. This situation is not peculiar to Nigeria as studies have shown that in the United States of

America, income is a determinant of access to health facilities, as many studies indicate that higher-

income earners have more access to healthcare than lower-income earners. For instance, “in 2009–2010,

people of all racial and ethnic groups who were 18–64 years old and had a family income below 200

percent of the poverty threshold were more likely than those who had a higher family income to delay

seeking or fail to obtain essential medical treatment because of cost” (NCHS, 2016). Failure to access

medical facilities was more pronounced amongst families who live below the poverty level and those

whose income was between 100-190% poverty level (NCHS, 2016).

A possible reason for this outcome is that if an elderly person does not have enough finances to fund her

hospital expenses, she would most likely resort to traditional healing homes in order to access healthcare.

Similarly, findings indicate that those who have low health literacy as a result of their educational

qualifications or exposure are more likely to make excuses on why they should not access the PHC.

Hence, they are less likely to seek medical care in situations of ill health. In the same vein, low family
52
support owing to lack or poverty in a family as well as inaccessibility to health insurance were also

highlighted as socioeconomic variables influencing the utilisation of PHCs amongst the elderly. This

could be explained by the fact that poor elderly women might be left lonely in the hinterlands, with little

or no help to access healthcare, thus affecting their ability to visit the PHCs when they have health

challenges.

Secondly, the study found that elderly women’s level of education influences their utilisation of primary

healthcare. This finding is in line with some past findings. For instance, Ensor and Cooper (2004), found

that a significant number of persons surveyed who did not have problems paying for health services

attained a college education. Additionally, Ensor, and Cooper (2004), observed that “educational

attainment is connected with an improved awareness of sickness, symptoms, and availability of services

and its consumption”. The above findings were also in agreement with study by Oladigbolu, and Oche

(2017), who found that half of the participants who easily paid for their health services were civil servants

with health insurance or the means to offset the medical bills. Relatedly, Ahmed, et al. (2005), found that

“level of education and income are positively correlated with utilisation of healthcare services, adding

that unequal access to primary healthcare is mainly due to inequalities in socioeconomic status”. A

possible reason for this correlation between education and accessibility to healthcare amongst the elderly

is that education offers one more chance to be employed and earn legitimate means of paying for a health

service than non-educated persons. Also, those who were able to engage in paid employment owing to

their education, have easier access to health insurance than the undedicated ones. Furthermore, one can

also conclude that education empowers elderly women to take control of their health, as women with

higher levels of education may have greater confidence in making healthcare decisions for themselves.

They may be more proactive in seeking out PHC services and advocating for their health needs when

compared to those with lower levels of education. The reason for this result may not also be unconnected

to the fact that education can sometimes lead to changes in cultural and social norms. Elderly women

53
with higher levels of education may be more inclined to challenge traditional gender roles or

expectations, which could result in increased autonomy in healthcare decision-making and utilisation of

services.

Furthermore, the study investigated if elderly women’s area of residence has a significant influence on

their utilisation of primary healthcare. Findings revealed that the participant's area of residence indeed

has a significant influence on the utilisation of primary healthcare (PHC) services amongst elderly

women in Lagos Metropolis. In line with this finding, Ahmed et. al., (2021), found that the location of

healthcare centres and the accessibility of healthcare workers at the centres significantly impact the

utilisation of healthcare centres amongst rural and urban communities. In Nigeria and elsewhere, distance

has been cited as a barrier to the use of PHC services, particularly in rural regions (Nwokoro, et al.,

2017). The Federal Ministry of Health (2020) found that “as much as 43% of respondents in a study

stated that obstacles to using health care services at both rural and urban facilities included high

transportation costs, high costs for medication and services at the health centre, and lost man-hours due

to distance of patient’s residents to the PHCs. Equally, a study by Sule et al. (2008) has also blamed the

low utilisation of PHC in rural areas on the high cost of health services in Nigeria. For instance, the

researcher found that “about 40% of their respondents were living in poverty while close to 27% live in

extreme poverty” (Sule et al., 2008). The reasons for this finding may be attributed to the fact that in

urban settings, elderly women might have better transportation options, such as public transportation or

ride-sharing services, making it easier for them to reach healthcare facilities. Meanwhile, in rural areas,

elderly women may face transportation challenges. Limited or irregular public transportation, long

distances to healthcare facilities, and poor road conditions can deter them from seeking healthcare. Also,

urban areas often receive more attention and resources from local healthcare authorities, leading to better

healthcare infrastructure and services. On the contrary, rural areas may face resource constraints and a

lack of healthcare policy prioritisation, leading to lower service quality in PHCs located in rural areas.

54
The study further found that poor quality primary healthcare facilities and availability are significant

predictors of utilisation among elderly women in Lagos Metropolis. The quality of facilities and the

presence of well-trained personnel directly influence whether elderly women seek primary healthcare

services. In line with the current finding, Nwokoro et al. (2022), in their report, asides from the issue of

the high cost of service in PHCs, the main reasons for the non-use of PHCs are low-quality healthcare,

inadequate medical personnel, and waiting for a long time before being attended to. Likewise, in another

study by Ige, and Nwachukwu (2010) in Nigeria, long waiting periods and inadequate medical personnel

at the PHCs are the leading factors preventing elderly persons from accessing healthcare. Ige and

Nwachukwu (2010), further reported that long waiting times by patients and insufficient drugs often

discourage patients, especially elderly patients from accessing healthcare. This result connotes that when

the facilities in the PHCs are inadequate in a way that supports proper medical care, the possibility for

elderly patients to reduce patronage is high. Meanwhile, beyond just the physical attributes of the

facilities, the quality of care provided at primary healthcare facilities could influence the willingness to

seek healthcare from the centres by elder women. This is because inadequate infrastructure, a shortage

of medical personnel, and a lack of essential medical supplies can result in poor healthcare services.

Also, elderly women, who often require special care due to age-related health illness, maybe particularly

sensitive to these deficiencies in the PHCs. Improving these infrastructural deficiencies and addressing

the barriers posed by inadequate personnel are essential steps to promote better utilisation of primary

healthcare by elderly women in the Lagos metropolis.

Lastly, the study found that access to traditional medicine influences the utilisation of primary health

care amongst elderly women in the Lagos metropolis. finding show that some cultural factors/beliefs

influence elderly people’s decision to utilise the PHCs. These factors can therefore have significant

implications for the overall health outcomes of elderly women, including delayed diagnoses, missed

opportunities for preventive care, and the potential exacerbation of health problems. Although there is a

55
dearth of research on the relationship between access to traditional medicine and utilization of PHCs, a

possible reason for this outcome could be that when elderly women have more access to cheaper herbal

mixtures, they tend to patronise the traditional medicine due to ease of access and lower cost. Also, some

ailments traditionally are believed to be better treated with traditional medicines than making use of

modern healthcare services.

56
 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATION

5.1 Summary

The study investigated the Socio-Economic Factors Influencing Elderly Women's Utilisation of Primary

Healthcare Services in Yaba Local Government Area. The study answered five research questions which

yielded five major findings. They include:

Firstly, the research established that socioeconomic status plays a pivotal role in elderly women's

utilisation of primary healthcare services. Factors such as financial constraints, education level, health

literacy, and family support, were identified as crucial determinants.

Also, the level of education was found to be a significant influence on the utilisation of primary

healthcare among elderly women. Participants noted that better levels of education are associated with

better healthcare awareness, improved healthcare decision-making, and increased access to health

insurance.

Equally, the area of residence emerged as a critical factor affecting the utilisation of primary healthcare.

Urban areas are perceived as more favourable for elderly women to access healthcare due to better

transportation options and more developed healthcare infrastructure.

Furthermore, poor-quality primary healthcare facilities, inadequate medical personnel, and long waiting

times due to inadequate personnel were identified as barriers to utilisation among elderly women. Access

to better healthcare services is crucial for encouraging utilisation.

Lastly, Access to traditional medicine was found to influence elderly women's decisions to utilise

primary healthcare services, just as cultural beliefs and preferences for traditional remedies played a role

in healthcare choices.

57
5.2 Conclusion

The current study highlighted the multi-layered nature of socio-economic factors influencing the

utilisation of primary healthcare services amongst elderly women in Yaba Local Government Area,

Lagos State. In conclusion, the research observed that financial constraints, education levels, family

support, health insurance, as well as geographical barriers, amongst others play pivotal roles in

determining access to healthcare amongst elderly females. Additionally, the quality of healthcare

facilities and the presence of well-trained personnel were also identified as critical factors in the

utilisation of primary healthcare. Furthermore, access to traditional medicine had a significant influence

on healthcare utilisation, driven by cultural beliefs, affordability, accessibility, and a lack of health

education.

5.3 Recommendations

Based on the findings of the present study, the following recommendations are hereby suggested:

The government should provide special health insurance schemes for the elderly, especially those who

are not civil servants. They can also subsidise health services or financial assistance programmes to

alleviate the financial burden on elderly women seeking healthcare, either in the PHCs or elsewhere.

This will go a long way to enhance more utilisation of PHCs amongst those with low socioeconomic

status, implement health education campaigns to improve health literacy among elderly women, bridging

the knowledge gap and promoting early healthcare seeking. Conducting health education programmes

targeting elderly women to enhance their health literacy and empower them to make informed healthcare

decisions will go a long way to boost the utilisation of PHCs in their locality.

Furthermore, the government should Invest in upgrading and maintaining the quality of primary

healthcare facilities, ensuring that they are well-equipped, staffed, and efficient. This will boost the

confidence of the public, particularly elder women in the ability of the PHCs to treat them, thus increasing

their utilization of primary healthcare facilities.

58
Initiatives should be implemented to improve the accessibility of primary healthcare services,

particularly in rural areas. This includes investing in transportation infrastructure and reducing healthcare

costs for elderly women. This makes it possible for residents to access PHCs with relative ease.

5.4 Suggestions for Future Research

To further expand our understanding of the factors influencing elderly women's healthcare utilization,

future research could investigate the role of cultural beliefs and traditional medicine in-depth to

understand how they impact healthcare choices. Also, future studies can also conduct comparative

studies across different local government areas in Lagos State. This can provide insights into regional

variations in healthcare utilisation among elderly women.

5.5 Contributions to Knowledge

This study contributes to the existing body of knowledge by demonstrating the intricate relationship

between socioeconomic factors and healthcare utilisation among elderly women. It accentuates the

importance of addressing these factors to ensure equitable access to primary healthcare services for this

vulnerable population. Additionally, the study highlights the influence of cultural factors, an area that

has received limited attention in previous research, in shaping healthcare decisions among elderly

women. These findings provide valuable foundations for designing targeted healthcare policies and

interventions to improve the well-being of elderly women in Yaba Local Government Area, Lagos State,

in particular and Nigeria in general.

59
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66
 APPENDIX I

UNIVERSITY OF LAGOS, LAGOS NIGERIA

SCHOOL OF POSTGRADUATE STUDIES
MASTER IN PUBLIC AND INTERNATIONAL AFFAIRS PROGRAMME
INTERVIEW QUESTIONS FOR THE STUDY OF SOCIOECONOMIC FACTORS
INFLUENCING ELDERLY WOMEN'S UTILISATION OF PRIMARY HEALTHCARE
SERVICES IN LAGOS METROPOLIS.

SECTION A: DEMOGRAPHIC DETAILS

1. Name of PHC ___________________________________________

2. Age ____________________________________________

SECTION B: INTERVIEW QUESTIONS

1. Do you think that rural and urban dwellers' economic status influences their visit to PHC when
experiencing health challenges?
Comments

2. Please describe an incident where a patient fails to attend a treatment plan because of lack of
money.
Comments

__________________________________________________________________________________

3. How might socioeconomic status impact the utilization of primary health care services among

elderly women in Lagos Metropolis?

Comments

4. Do you believe any specific factors or variables are particularly influential in this context?

Comments

__________________________________________________________________________________
67
 5. To what extent do people complain that distance to health centres prevents them from coming to

PHC?

Comments

__________________________________________________________________________________

6. Can you provide examples or insights into any potential differences in the utilization of primary

health care services among elderly women based on their area of residence?

Comments

__________________________________________________________________________________

7. Are there any particular areas or neighborhoods that you believe face unique challenges or

advantages when accessing and utilizing these services?

Comments

__________________________________________________________________________________

8. To what extent do you think that residents' use of local herbs prevents them from accessing

healthcare?

Comments

__________________________________________________________________________________

9. Can you share any insights or observations on how access to traditional medicine may influence

primary health care services utilisation among elderly women in Lagos Metropolis?

Comments

__________________________________________________________________________________

10. Are there any specific ways in which the availability or utilization of traditional medicine impacts

their decision-making process when seeking primary health care?

Comments

_________________________________________________________________________________

68
 11. In your experience or knowledge, what are some potential reasons why elderly women in Lagos

Metropolis might choose traditional medicine over primary health care services?

Comments

_________________________________________________________________________________

12. How does this preference for traditional medicine impact their utilization patterns, and what are

some potential implications for their overall health outcomes?

Comments

__________________________________________________________________________________

13. Do you think that lack of adequate information on services offered by PHC affects elderly

women’s visit to PHC?

Comments

14. If yes please can you suggest how this can be solved?

Comments

__________________________________________________________________________________

15. To what extent do you think that educational attainment can influence an elderly woman’s belief

in the ability of PHC to treat her when faced with health challenges?

Comments

_________________________________________________________________________________

16. Based on your experience, are there any particular barriers or facilitators that elderly women in

Lagos Metropolis may encounter when it comes to utilizing primary health care services?

Comments

_________________________________________________________________________________

17. If so, what are they?

69
Comments

_________________________________________________________________________________

18. How do these influence their decision-making process?

Comments

_________________________________________________________________________________

19. Does quality of service and availability of health facilities affect elderly women’s visit to PHC

when they need healthcare?

Comments

_________________________________________________________________________________

20. If yes, can you please be specific on things to be done to provide better health services?

Comments

__________________________________________________________________________________

21. From your experience or knowledge, do you believe that the quality or condition of primary

health care facilities in Lagos Metropolis has an impact on the utilization of these services by

elderly women?

Comments

__________________________________________________________________________________

22. If so, how can poor primary healthcare facilities influence their utilisation patterns?

Comments

__________________________________________________________________________________

23. To what extent do inadequate health centres and personnel discourage elderly women from

accessing the PHC?

Comments

__________________________________________________________________________________

24. What can be the immediate/long-term solution to this?

70
Comments

__________________________________________________________________________________

25. Do you think that lack of community linkage roads and distance can affect elderly women’s

access to PHC in urban and rural areas?

Comments

26. Aside from the factors highlighted above, can you please list other factors you think can affect

elderly women’s use of PHC both in urban and rural areas?

Comments

__________________________________________________________________________________

71
 APPENDIX II

RESEARCH QUESTION ONE

Name: Nodes\\Education and Health Literacy

<Internals\\TRANSCRIPTS> - § 18 references coded [5.46% Coverage]

Reference 1 - 0.15% Coverage

They can attend health education programs, buy necessary medications, and prioritize their well-being.

Reference 2 - 0.16% Coverage

I work closely with elderly women in Lagos, and I've found that education is a significant socioeconomic

factor.

Reference 3 - 0.17% Coverage

Women with higher levels of education tend to be more aware of the importance of regular check-ups

and preventive care.

Reference 4 - 0.45% Coverage

These interventions could include mobile clinics for rural areas, telemedicine services, and community

health education programs to raise awareness about the importance of regular primary healthcare visits.

By addressing these differences, we can work towards more equitable access to healthcare for all elderly

women.

Reference 5 - 0.32% Coverage

Yes, I believe that areas with poor road network and low level of education tend to have limited access

to PHCs. Fortunately, in Lagos that we have relatively good access to good transportation system, such

change is not rife.

Reference 6 - 0.20% Coverage

In my experience, education and awareness campaigns can help bridge the gap by encouraging residents

72
to seek medical advice when necessary.

Reference 7 - 0.23% Coverage

It's important to provide education about the benefits and limitations of local herbs and promote the

importance of seeking professional medical care when needed.

Reference 8 - 0.18% Coverage

Health education programs that emphasize the importance of regular check-ups and preventive

healthcare can help strike a balance.

Reference 9 - 0.23% Coverage

However, education is key. By raising awareness about the benefits of combining traditional and primary

healthcare, we can encourage more informed decision-making.

Reference 10 - 0.28% Coverage

I have noticed that some elderly women in Lagos Metropolis might prefer traditional medicine over

primary health care services due to a lack of awareness and education about modern healthcare options.

Reference 11 - 0.41% Coverage

When elderly women opt for traditional medicine, they may not receive this crucial education.

Consequently, they may be less informed about managing their health, which can negatively impact their

overall health outcomes, especially in terms of preventable diseases and health maintenance.

Reference 12 - 0.25% Coverage

Creating awareness through community outreach and educational programs is crucial to addressing this

issue and ensuring that elderly women have access to the care they require.

Reference 13 - 0.28% Coverage

Better communication and education are essential to inform elderly women about the benefits of PHC

and to encourage them to seek regular medical attention, ultimately improving their health outcomes.
73
Reference 14 - 0.32% Coverage

Firstly, there should be community-based health education programs specifically designed for elderly

women. These programs can use local resources and trusted community members to disseminate

information about PHC services.

Reference 15 - 0.24% Coverage

One approach is to establish community health education programs that target this demographic,

providing information about the range of services available at PHC centers.

Reference 16 - 0.28% Coverage

. Community health workers can conduct regular outreach and educational sessions in local

neighborhoods, explaining the services offered by PHC centers and addressing any concerns or

misconceptions.

Reference 17 - 0.72% Coverage

I believe educational attainment plays a significant role in shaping an elderly woman's belief in the

effectiveness of PHC. Having completed high school, I understand the importance of seeking

professional medical help when needed. I have confidence in PHC because I've learned about it during

my education. However, I also know that not everyone had the same opportunities, so it's essential to

provide accessible and understandable healthcare information to all elderly women, regardless of their

education.

Reference 18 - 0.57% Coverage

I think education does play a role, but it's not the sole determinant of an elderly woman's belief in PHC.

While I've had some college education, I've also seen that personal experiences and cultural beliefs can

strongly influence one's perceptions of healthcare. It's crucial to provide information in a way that

respects different educational backgrounds and takes into account individual perspectives

74
Name: Nodes\\Family Support

<Internals\\TRANSCRIPTS> - § 7 references coded [2.13% Coverage]

Reference 1 - 0.27% Coverage

The expenses for chemotherapy, medications, and hospital stays were overwhelming for our family.

Despite our best efforts to gather funds, we couldn't keep up with the mounting medical bills.

Reference 2 - 0.41% Coverage

We're fortunate to have a family with some financial resources, so we can afford her medical needs. But

I know many elderly women who struggle because their families can't cover the costs. It's clear that

financial status greatly influences their ability to use primary healthcare services.

Reference 3 - 0.24% Coverage

In my role as a caregiver for elderly women, I've observed that family support is crucial. Many elderly

women rely on their families for emotional and financial assistance.

Reference 4 - 0.12% Coverage

When they have supportive family structures, it's easier for them to access healthcare.

Reference 5 - 0.26% Coverage

I think that elderly women in urban areas often have a more robust support network, including family

members and caregivers, which facilitates their access to primary healthcare services.

Reference 6 - 0.45% Coverage

For elderly women who struggle with language barriers like me, it can be intimidating to visit a

healthcare facility where we may not fully understand what the doctors or nurses are saying. This often

leads to delays in seeking care because we may wait until a family member or friend can accompany us

and translate.

75
Reference 7 - 0.36% Coverage

Caregiver burden is something I have seen firsthand. In urban areas, family members often play a crucial

role in decision-making for elderly women's healthcare. If caregivers are overwhelmed or unaware of

available services, it can hinder PHC utilization.

Name: Nodes\\Financial Constraints

<Internals\\TRANSCRIPTS> - § 23 references coded [6.06% Coverage]

Reference 1 - 0.10% Coverage

In my village, many people, including myself, face financial constraints.

Reference 2 - 0.12% Coverage

So, yes, financial constraints do discourage many from seeking timely medical help.

Reference 3 - 0.15% Coverage

While economic status can influence healthcare decisions in urban areas, it's not the sole determinant.

Reference 4 - 0.18% Coverage

In cities, there are often more job opportunities and better access to health insurance, which can mitigate

financial barriers

Reference 5 - 0.17% Coverage

I've encountered several instances where patients couldn't continue their treatment plans due to

financial constraints

Reference 6 - 0.25% Coverage

Unfortunately, she had to discontinue her treatment because she couldn't afford it. It was heartbreaking

to witness her health deteriorate because of financial limitations.

76
Reference 7 - 0.22% Coverage

She was initially committed to her treatment plan but soon faced financial constraints due to her inability

to work full-time while caring for her children.

Reference 8 - 0.16% Coverage

I have worked in communities where access to healthcare is limited, and patients often face financial

barriers.

Reference 9 - 0.24% Coverage

He was living on a fixed income and couldn't afford the procedure. Despite exploring various avenues

for financial assistance, he eventually gave up on the treatment plan.

Reference 10 - 0.26% Coverage

Well, I think socioeconomic status plays a significant role. If you have a stable income and access to

health insurance, you are less likely to use primary healthcare services regularly.

Reference 11 - 0.15% Coverage

Many elderly women in Lagos like me might skip check-ups or delay treatment due to financial

constraints.

Reference 12 - 0.33% Coverage

In my experience, socioeconomic status does impact healthcare utilization among elderly women. Those

with higher incomes are more likely to afford transportation to healthcare facilities and out-of-pocket

expenses for medications.

Reference 13 - 0.22% Coverage

However, lower-income elderly women may delay or avoid medical visits due to cost concerns, which

can lead to more severe health issues in the long run.

77
Reference 14 - 0.13% Coverage

Those with better financial stability are more proactive in using primary healthcare services.

Reference 15 - 0.22% Coverage

In contrast, women from lower socioeconomic backgrounds often face barriers like limited access to

transportation and an inability to afford medications.

Reference 16 - 0.14% Coverage

We're fortunate to have a family with some financial resources, so we can afford her medical needs.

Reference 17 - 0.48% Coverage

We need to work towards a more inclusive healthcare system that considers the financial constraints

faced by lower-income individuals. This might involve expanding insurance coverage, subsidizing

healthcare costs, and improving the accessibility of primary healthcare services to ensure that all elderly

women can access the care they need.

Reference 18 - 0.30% Coverage

In my experience, one of the most influential socioeconomic factors is income level. Many elderly

women in Lagos Metropolis have limited financial resources, and this affects their ability to seek

healthcare.

Reference 19 - 0.58% Coverage

I work closely with elderly women in Lagos, and I've found that education is a significant socioeconomic

factor. Women with higher levels of education tend to be more aware of the importance of regular check-

ups and preventive care. They are also more likely to navigate the healthcare system effectively. In

contrast, those with limited education may lack health literacy and face barriers in accessing care.

78
Reference 20 - 0.55% Coverage

In my role as a caregiver for elderly women, I've observed that family support is crucial. Many elderly

women rely on their families for emotional and financial assistance. When they have supportive family

structures, it's easier for them to access healthcare. However, those who lack family support may struggle

to prioritize their health due to loneliness and financial constraints.

Reference 21 - 0.49% Coverage

Cost is a significant barrier. Healthcare expenses can be overwhelming, especially when you're living on

a limited income. On the positive side, I've found that some primary health centers offer subsidized

services or have partnerships with NGOs that provide financial assistance. These facilitators help ease

the financial burden for elderly women.

Reference 22 - 0.38% Coverage

Financial constraints are a significant influence on our decision-making process. We may delay seeking

care or skip follow-up appointments if we can't afford it. It's a tough choice between spending money on

healthcare or other essential needs like food and housing.

Reference 23 - 0.23% Coverage

Also, economic constraints can be a significant issue as some elderly women may not have the means to

afford healthcare services even if they are available nearby.

Name: Nodes\\Health Insurance Cover

<Internals\\TRANSCRIPTS> - § 6 references coded [1.30% Coverage]

Reference 1 - 0.18% Coverage

In cities, there are often more job opportunities and better access to health insurance, which can mitigate

financial barriers.

79
Reference 2 - 0.18% Coverage

If you have a stable income and access to health insurance, you are less likely to use primary healthcare

services regularly.

Reference 3 - 0.29% Coverage

This might involve expanding insurance coverage, subsidizing healthcare costs, and improving the

accessibility of primary healthcare services to ensure that all elderly women can access the care they

need.

Reference 4 - 0.26% Coverage

Health insurance coverage is a significant socioeconomic factor in this context. Elderly women who have

health insurance are less likely to reduce visit to primary healthcare services.

Reference 5 - 0.26% Coverage

Insurance can help alleviate the financial burden of medical expenses and encourage regular check-ups

in private hospitals and other higher government care facilities other than the PHC.

Reference 6 - 0.13% Coverage

Lack of insurance coverage can be a motivating factor for elderly patients to utilise PHCs.

THEMES FOR RESEARCH QUESTION TWO

<Internals\\TRANSCRIPTS> - § 4 references coded [0.91% Coverage]

Reference 1 - 0.30% Coverage

Improved communication and outreach efforts are necessary to inform elderly women about the range

of healthcare services available, including preventive care, screenings, and management of chronic

conditions.

Reference 2 - 0.28% Coverage

Better communication and education are essential to inform elderly women about the benefits of PHC

80
and to encourage them to seek regular medical attention, ultimately improving their health outcomes.

Reference 3 - 0.18% Coverage

Addressing the lack of information about PHC services for elderly women involves improving

communication and outreach efforts.

Reference 4 - 0.15% Coverage

Language and communication can be a barrier, especially for elderly women who may not be fluent in

English.

<Internals\\TRANSCRIPTS> - § 5 references coded [1.19% Coverage]

Reference 1 - 0.24% Coverage

However, factors like education, awareness, and cultural beliefs also play a role in determining whether

someone seeks healthcare, regardless of their economic status.

Reference 2 - 0.20% Coverage

Some elderly women have strong cultural beliefs and trust in traditional healing methods, could lead

them to rely more on traditional medicine.

Reference 3 - 0.18% Coverage

On one hand, it can empower individuals to take control of their health and seek remedies that align with

their cultural beliefs.

Reference 4 - 0.17% Coverage

I have also seen that personal experiences and cultural beliefs can strongly influence one's perceptions

of healthcare.

Reference 5 - 0.39% Coverage

I believe cultural beliefs and stigma can play a significant role. Some elderly women in urban areas might

avoid seeking PHC due to traditional beliefs or fear of being judged. Additionally, transportation issues,
81
especially in congested urban areas, can be a barrier for them.

<Internals\\TRANSCRIPTS> - § 8 references coded [2.09% Coverage]

Reference 1 - 0.26% Coverage

Having completed high school, I understand the importance of seeking professional medical help when

needed. I have confidence in PHC because I've learned about it during my education.

Reference 2 - 0.18% Coverage

With a University education, I have a deeper understanding of the medical field and can critically

evaluate healthcare options.

Reference 3 - 0.29% Coverage

I didn't have much formal education, just elementary school. However, I believe in PHC because I've

witnessed its benefits over the years. My trust in it comes from personal experiences and formal

education.

Reference 4 - 0.19% Coverage

Elderly women with a higher level of education often have a better understanding of medical treatments

and are more likely to trust PHC.

Reference 5 - 0.18% Coverage

My technical school education has given me some insight into healthcare, but I also recognize the value

of personal experiences.

Reference 6 - 0.36% Coverage

My belief in PHC stems from both my education and the positive outcomes I have observed. To promote

trust in PHC among elderly women, we should offer clear and simple information to bridge any

knowledge gaps, regardless of their educational background.

82
Reference 7 - 0.39% Coverage

Health literacy barriers can lead to a lack of understanding about the importance of early intervention. If

we don't fully comprehend the severity of our health issues or how to access care, we might delay seeking

help until our conditions worsen, impacting our overall health.

Reference 8 - 0.23% Coverage

uality is equally important; if the services are professional and respectful, I will have confidence in the

care I receive, which makes me more likely to visit.

OUTPUTS FOR RESEARCH QUESTIN THREE

<Internals\\TRANSCRIPTS> - § 2 references coded [0.67% Coverage]

Reference 1 - 0.32% Coverage

One significant difference we observed is the utilization of community health workers in urban and rural

areas. In rural areas, these workers play a crucial role in connecting elderly women with primary

healthcare services.

Reference 2 - 0.36% Coverage

Social isolation can't be overlooked. Elderly women in urban areas may face loneliness and a lack of

social support, which can affect their willingness to seek PHC. Engaging them in community activities

and support networks could make a big difference.

<Internals\\TRANSCRIPTS> - § 16 references coded [4.88% Coverage]

Reference 1 - 0.29% Coverage

have seen people in my village avoid going to the PHC because they can't afford it. Some have to travel

long distances to reach a healthcare facility, and the transportation costs alone can be a burden.

Reference 2 - 0.37% Coverage

Well, from my experience working in a rural healthcare setting, I can say that distance to health centers

83
is indeed a significant barrier for many people. Patients often complain about the long distances they

have to travel to access primary healthcare services.

Reference 3 - 0.36% Coverage

I have conducted community surveys on this very issue, and the results are quite telling. A considerable

number of respondents expressed frustration over the distance to health centers. They believe it prevents

them from seeking timely primary healthcare.

Reference 4 - 0.26% Coverage

While distance is a valid concern, it's not the only factor to consider. In my research, I've found that

socioeconomic status and access to transportation also play a significant role.

Reference 5 - 0.37% Coverage

Distance to health centers is undoubtedly a problem in accessing PHCs especially in the rural areas. For

instance, once missed out on critical healthcare check-up when I was in my village in Cross Rivers due

to the long travel times involved in accessing my PHC.

Reference 6 - 0.27% Coverage

Distance to PHCs s definitely a challenge to people of my age. Many of us, the elderly, especially those

with chronic conditions, find it extremely challenging to make the journey regularly.

Reference 7 - 0.29% Coverage

Traditional healers are often found within or near their communities, making it easier for them to access

care without traveling long distances or navigating the complexities of the formal healthcare system.

Reference 8 - 0.22% Coverage

have seen numerous instances where elderly women had to travel long distances to reach a healthcare

center, only to find it overcrowded and understaffed.

84
Reference 9 - 0.23% Coverage

This is because, in some instances, elderly women had to travel long distances to reach a health center,

only to find it overwhelmed with patients and understaffed.

Reference 10 - 0.26% Coverage

Yes, I believe that the lack of community linkage roads and long distances can significantly impact

elderly women's access to primary healthcare services, especially in urban areas.

Reference 11 - 0.22% Coverage

Absolutely, the lack of community linkage roads and the distance to healthcare facilities pose a

significant challenge for elderly women in rural areas.

Reference 12 - 0.59% Coverage

From a healthcare provider's perspective, I can attest that the lack of community linkage roads and long

distances can indeed affect elderly women's access to primary healthcare in urban areas. Many elderly

women in urban settings may have chronic health conditions that require regular check-ups or treatments.

When they have to travel long distances or face roadblocks, it discourages them from seeking timely

care.

Reference 13 - 0.39% Coverage

As I have witnessed in the past in my village before my son brought me to Lagos, I can affirm that the

absence of community linkage roads and the considerable distance can be a significant obstacle for

elderly women's access to primary healthcare, both in urban and rural areas.

Reference 14 - 0.23% Coverage

Yes, I have personally experienced how the lack of community linkage roads and the distance to

healthcare centers affect elderly women in rural areas like myself.

85
Reference 15 - 0.31% Coverage

As a retired local government official, know that the lack of community linkage roads and long distances

can indeed have a detrimental impact on elderly women's access to primary healthcare in both urban and

rural areas.

Reference 16 - 0.21% Coverage

I think that access to healthcare facilities is a crucial factor. In rural areas, the distance to the nearest

clinic or hospital can be quite far.

<Internals\\TRANSCRIPTS> - § 10 references coded [2.84% Coverage]

Reference 1 - 0.26% Coverage

In urban areas, there is more awareness about the importance of regular check-ups and early intervention.

So, even if someone is on a tight budget, they might prioritize their health.

Reference 2 - 0.24% Coverage

However, factors like education, awareness, and cultural beliefs also play a role in determining whether

someone seeks healthcare, regardless of their economic status.

Reference 3 - 0.36% Coverage

They have better access to healthcare information and are generally more aware of the importance of

primary care. In contrast, elderly women in rural areas may not have the same level of awareness and

may only seek healthcare when they are seriously ill.

Reference 4 - 0.29% Coverage

These interventions could include mobile clinics for rural areas, telemedicine services, and community

health education programs to raise awareness about the importance of regular primary healthcare visits.

Reference 5 - 0.20% Coverage

In my experience, education and awareness campaigns can help bridge the gap by encouraging residents

86
to seek medical advice when necessary

Reference 6 - 0.39% Coverage

They may view traditional medicine as a more accessible and affordable option, even though it may not

always address their healthcare needs comprehensively. Enhancing awareness and accessibility of

primary healthcare services tailored to the elderly population is crucial.

Reference 7 - 0.28% Coverage

To promote better utilization of primary healthcare, it's essential to create awareness about the benefits

of early diagnosis and professional medical care, even alongside traditional practices.

Reference 8 - 0.24% Coverage

However, education is key. By raising awareness about the benefits of combining traditional and

primary healthcare, we can encourage more informed decision-making.

Reference 9 - 0.18% Coverage

Increasing awareness about the services and benefits of PHC is essential to encourage more elderly

women to seek care there.

Reference 10 - 0.41% Coverage

This lack of awareness can lead to missed opportunities for early intervention and health maintenance.

It's important to disseminate information about PHC services through various channels, including

community events and healthcare campaigns, to ensure that elderly women are well-informed.

<Internals\\TRANSCRIPTS> - § 3 references coded [1.04% Coverage]

Reference 1 - 0.13% Coverage

In my experience, socioeconomic status does impact healthcare utilization among elderly women.

Reference 2 - 0.50% Coverage

Those with better financial stability are more proactive in using primary healthcare services. They can

87
attend health education programs, buy necessary medications, and prioritize their well-being. In contrast,

women from lower socioeconomic backgrounds often face barriers like limited access to transportation

and an inability to afford medications.

Reference 3 - 0.41% Coverage

I believe that transportation and infrastructure are key socioeconomic factors. Lagos Metropolis has

significant traffic congestion and inadequate public transportation options. Elderly women who lack

access to reliable transportation may find it challenging to reach healthcare facilities.

OUTPUTS FOR RESEARCH QUESTION FOUR

<Internals\\TRANSCRIPTS> - § 6 references coded [1.06% Coverage]

Reference 1 - 0.17% Coverage

Enhancing awareness and accessibility of primary healthcare services tailored to the elderly population

is crucial.

Reference 2 - 0.18% Coverage

Absolutely, the quality of service and the availability of health facilities have a significant impact on

whether I visit PHC.

Reference 3 - 0.16% Coverage

For me, availability is crucial. If there's a PHC center nearby, I am more likely to go. But quality matters

too.

Reference 4 - 0.17% Coverage

The availability of health facilities is a big factor. If there's a center close to my home, I'm more inclined

to use it.

Reference 5 - 0.19% Coverage

I have noticed that when health facilities are readily available and offer good quality service, it
88
encourages me to seek care promptly.

Reference 6 - 0.19% Coverage

Yes, both factors are crucial. Availability means I don't have to travel far, which is especially important

when I'm not feeling well.

<Internals\\TRANSCRIPTS> - § 8 references coded [3.82% Coverage]

Reference 1 - 0.20% Coverage

Inadequate health centers and personnel play a significant role in discouraging elderly women from

accessing primary healthcare services (PHC).

Reference 2 - 0.40% Coverage

From my experience, when elderly women perceive that there are not enough healthcare facilities or

personnel to meet their needs, they often hesitate to seek care. They may fear long wait times, limited

attention from overworked staff, or the unavailability of necessary treatments.

Reference 3 - 0.22% Coverage

Well, I can say that inadequate health centers and personnel can be a major deterrent for elderly women

when it comes to accessing primary healthcare services.

Reference 4 - 0.22% Coverage

I have seen numerous instances where elderly women had to travel long distances to reach a healthcare

center, only to find it overcrowded and understaffed.

Reference 5 - 0.76% Coverage

From my perspective, inadequate health centers and personnel have a substantial negative impact on

elderly women's access to primary healthcare. So an elderly person, I often have multiple health needs,

and if they perceive that the facilities are unable to meet those needs due to understaffing or lack of

resources, they are less likely to seek care. It is therefore important to ensure that there are enough well-

89
equipped healthcare centers and trained personnel to provide the necessary care and encourage elderly

women to access PHC.

Reference 6 - 0.73% Coverage

Inadequate health centers and personnel can be a significant barrier to elderly women seeking primary

healthcare services. I have seen situations where elderly patients had to wait for hours to receive attention

at overcrowded facilities or couldn't access services due to a shortage of healthcare personnel. These

challenges discourage them from seeking timely care, which can have adverse health consequences.

Addressing these inadequacies is essential to make PHC more accessible and attractive to elderly women.

Reference 7 - 0.48% Coverage

Yes. I feel that inadequate health centers and personnel have a substantial impact on elderly women’s

utilization of primary healthcare services. Many elderly women may already have mobility or health

issues, and when they encounter overcrowded facilities or long waiting times due to a lack of personnel,

it can be highly discouraging.

Reference 8 - 0.80% Coverage

Inadequate health centers and personnel are a significant deterrent for elderly women when it comes to

accessing primary healthcare. This is because, in some instances, elderly women had to travel long

distances to reach a health center, only to find it overwhelmed with patients and understaffed. Inadequate

personnel and health facility can discourages them from seeking care and can lead to delayed treatment.

To encourage elderly women to access PHC, we need to ensure that there are sufficient healthcare

facilities and personnel available to meet their needs.

<Internals\\TRANSCRIPTS> - § 7 references coded [2.12% Coverage]

Reference 1 - 0.18% Coverage

Absolutely, the quality of service and the availability of health facilities have a significant impact on

whether I visit PHC.

90
Reference 2 - 0.27% Coverage

If I know there's a nearby facility with caring staff and efficient services, I'm more likely to seek

healthcare when needed. A positive experience encourages regular visits for check-ups.

Reference 3 - 0.31% Coverage

For me, availability is crucial. If there's a PHC center nearby, I am more likely to go. But quality matters

too. I will likely frequent a primary healthcare facility that has good health facility with ecelent

workforce.

Reference 4 - 0.42% Coverage

The availability of health facilities is a big factor. If there's a center close to my home, I'm more inclined

to use it. Equally, quality is equally important; if the services are professional and respectful, I will have

confidence in the care I receive, which makes me more likely to visit.

Reference 5 - 0.19% Coverage

I have noticed that when health facilities are readily available and offer good quality service, it

encourages me to seek care promptly

Reference 6 - 0.39% Coverage

Yes, both factors are crucial. Availability means I don't have to travel far, which is especially important

when I'm not feeling well. Quality matters because it affects my trust in the healthcare system. If I've

had positive experiences before, I'm more likely to return.

Reference 7 - 0.37% Coverage

Absolutely, availability and quality go hand in hand. If there's a nearby health facility that offers good

service, I am more likely to use it. But if the nearest option does not provide the care I need, I might try

to find a better one, which can delay my visit.

91
OUTPUT FOR RESEARCH QUESTION FIVE

<Internals\\TRANSCRIPTS> - § 13 references coded [5.35% Coverage]

Reference 1 - 0.36% Coverage

Yes, the availability of traditional medicine can significantly impact the decision-making process of

individuals when seeking primary healthcare. Some people may turn to traditional medicine first,

especially for culturally familiar or minor health issues.

Reference 2 - 0.58% Coverage

In my experience, the utilization of traditional medicine can sometimes lead to a delay in seeking primary

healthcare. People may initially rely on traditional remedies, hoping for a quick fix. This delay can be

risky, especially for conditions that require early medical intervention. It's essential to educate

individuals about when to complement traditional practices with professional healthcare services.

Reference 3 - 0.27% Coverage

The availability of traditional medicine can have a dual impact. On one hand, it can empower individuals

to take control of their health and seek remedies that align with their cultural beliefs.

Reference 4 - 0.31% Coverage

I've seen that the availability of traditional medicine often influences people's initial decision-making

when they fall ill. They may opt for traditional treatments first due to cultural familiarity or accessibility.

Reference 5 - 0.33% Coverage

The utilization of traditional medicine can impact decision-making significantly. Elderly persons often

have trust in traditional practitioners and may choose them as their first point of contact when they

experience health issues.

Reference 6 - 0.24% Coverage

I have observed that the availability of traditional medicine can lead individuals to explore various

healthcare options before settling on primary healthcare services.

92
Reference 7 - 1.04% Coverage

In my observation, elderly women in Lagos Metropolis choose traditional medicine over primary health

care services for several reasons. Firstly, they may have grown up in a culture that places a strong

emphasis on traditional healing practices, and they trust the knowledge and effectiveness of traditional

healers. Secondly, traditional medicine is often more accessible and affordable compared to formal

healthcare, which can be a significant factor for elderly women who may be on a fixed income or have

limited mobility. Lastly, some elderly women might prefer traditional medicine because it provides a

more holistic approach to health, taking into account not just physical symptoms but also spiritual and

emotional well-being.

Reference 8 - 0.26% Coverage

Based on my knowledge, elderly women in Lagos Metropolis might opt for traditional medicine over

primary health care services due to a lack of trust in modern medical practices. They

Reference 9 - 0.45% Coverage

Well, from what I've observed, elderly women in Lagos Metropolis may choose traditional medicine

over primary health care services because of a perceived sense of community and comfort. Traditional

healers are often members of the same community and are familiar with the patients' cultural background

and lifestyle.

Reference 10 - 0.23% Coverage

traditional medicine sometimes involves rituals and ceremonies that have cultural significance, which

can provide a sense of belonging and purpose for these women.

Reference 11 - 0.28% Coverage

I have noticed that some elderly women in Lagos Metropolis might prefer traditional medicine over

primary health care services due to a lack of awareness and education about modern healthcare options.

93
Reference 12 - 0.30% Coverage

From my knowledge, elderly women in Lagos Metropolis might choose traditional medicine over

primary health care services because of its affordability, as well as the stigma associated with seeking

medical help.

Reference 13 - 0.71% Coverage

I have observed that elderly women in Lagos Metropolis might opt for traditional medicine over primary

health care services due to the convenience of location. Traditional healers are often found within or near

their communities, making it easier for them to access care without traveling long distances or navigating

the complexities of the formal healthcare system. This convenience factor is crucial, especially for

elderly women who may have mobility limitations or rely on public transportation.

<Internals\\TRANSCRIPTS> - § 10 references coded [2.96% Coverage]

Reference 1 - 0.24% Coverage

However, factors like education, awareness, and cultural beliefs also play a role in determining whether

someone seeks healthcare, regardless of their economic status.

Reference 2 - 0.31% Coverage

Local herbs are deeply rooted in the cultural and traditional practices of many communities. While they

may provide some relief for minor health concerns, they should not be a substitute for professional

healthcare.

Reference 3 - 0.33% Coverage

I've worked in healthcare advocacy, and I've seen instances where residents' use of local herbs has

prevented them from accessing healthcare services. This is especially common in rural areas with limited

healthcare infrastructure.

94
Reference 4 - 0.56% Coverage

I have encountered situations where residents' use of local herbs has resulted in a delay in seeking

healthcare, particularly among older patients. They often rely on traditional remedies out of habit and

may only consult healthcare providers when their conditions worsen. Encouraging a more balanced

approach that incorporates both traditional remedies and modern healthcare can be beneficial.

Reference 5 - 0.33% Coverage

Some elderly women have strong cultural beliefs and trust in traditional healing methods, could lead

them to rely more on traditional medicine. This reliance may result in delayed or limited utilization of

primary healthcare services.

Reference 6 - 0.24% Coverage

These practitioners are deeply embedded in the local culture and communities. Some elderly women

prefer traditional medicine due to its familiarity and cultural relevance.

Reference 7 - 0.23% Coverage

Some people may turn to traditional medicine first, especially for culturally familiar or minor health

issues. They see it as a quicker and more accessible option.

Reference 8 - 0.19% Coverage

On one hand, it can empower individuals to take control of their health and seek remedies that align

with their cultural beliefs.

Reference 9 - 0.30% Coverage

They may opt for traditional treatments first due to cultural familiarity or accessibility. This can

sometimes lead to suboptimal healthcare outcomes if their condition requires professional medical

attention.

95
Reference 10 - 0.25% Coverage

I believe cultural beliefs and stigma can play a significant role. Some elderly women in urban areas might

avoid seeking PHC due to traditional beliefs or fear of being judged.

<Internals\\TRANSCRIPTS> - § 3 references coded [1.31% Coverage]

Reference 1 - 0.48% Coverage

have conducted surveys in communities that rely heavily on local herbs, and it's clear that some residents

view them as a primary healthcare option. While herbs can offer benefits, they may not always address

underlying health issues effectively. This can lead to delayed diagnosis and treatment, which can be

detrimental in certain cases.

Reference 2 - 0.29% Coverage

cultural beliefs and trust in traditional healing methods, could lead them to rely more on traditional

medicine. This reliance may result in delayed or limited utilization of primary healthcare services.

Reference 3 - 0.54% Coverage

When elderly individuals choose traditional medicine over PHC, it often leads to underutilization of

formal healthcare services. This can result in delayed diagnoses and treatments for serious medical

conditions. Consequently, their overall health outcomes may worsen over time, as timely medical

intervention is essential for managing chronic diseases and preventing complications.

<Internals\\TRANSCRIPTS> - § 6 references coded [1.90% Coverage]

Reference 1 - 0.55% Coverage

To address the lack of adequate information on services offered by PHC and encourage elderly women

to visit these facilities, we can implement several strategies. Firstly, there should be community-based

health education programs specifically designed for elderly women. These programs can use local

96
resources and trusted community members to disseminate information about PHC services.

Reference 2 - 0.37% Coverage

One approach is to establish community health education programs that target this demographic,

providing information about the range of services available at PHC centers. These programs can also

emphasize the benefits of preventive care and early intervention.

Reference 3 - 0.21% Coverage

Facilitators like health education programs in the community can empower us with the knowledge we

need to make informed decisions about our health.

Reference 4 - 0.37% Coverage

I believe there should be more health education programs tailored specifically for elderly women. These

programs can help improve our health literacy and empower us to make informed decisions about our

well-being. Knowledge is crucial for better healthcare.

Reference 5 - 0.25% Coverage

I would like to emphasize health literacy. In both urban and rural areas, elderly women might not have

sufficient knowledge about their healthcare needs or the available services.

Reference 6 - 0.16% Coverage

Promoting health education and awareness campaigns tailored to their needs can make a significant

difference.

97