Health Education on Access to Delivery Care Services in Nigeria


This research was conducted to evaluate the effect of health education, related to delivery care services, on knowledge and behavior of a specific group of population; women in childbearing period in certain area in Nigeria. The research aimed to answer the following questions:

  1. What is the knowledge level of delivery care services among the targeted group before and after the health education intervention programme?
  2. What is the effect of the intervention on the behavior of the targeted group for seeking delivery care services?

The authors put the following two null hypotheses:

  1. Health education intervention programme has no effect on raising knowledge level among the targeted group.
  2. Health education intervention programme has no effect on increasing the willingness for utilizing the delivery care services.

The researchers adopted a quasi-experimental design based on a questionnaire for collecting the required data from the purposive sample. The sample was divided into a control group and an experimental group. They used a split-half test of reliability for assessment of reliability of the questionnaire, and descriptive and inferential statistics for analyzing the data collected to answer the research questions and test the hypotheses respectively. They found that the health education intervention programme significantly improved the level of knowledge among the experimental group, but did not improve their behavior for trying to obtain the delivery care services.

Evaluation of the research methods

The topic of the research, delivery care services, is considered a very important health issue. In 2015, about 99% of global maternal deaths occurred in developing regions. Sub-Saharan Africa witnessed about 66%, with Nigeria alone accounting for 19% of global maternal deaths (approximately 58 000 maternal deaths)  (WHO, UNICEF, UNFPA, World Bank Group, & the United Nations Population Division, 2015). The authors provided a relevant literature review; explaining the burden of the problem, possible attributing factors and suggestions for handling the problem from comparable studies.

The design of the study was a quasi-experimental research, which used a pre-test and a post-test design. The sample used in the study was 120 women in childbearing period, pregnant or having children, from two districts of Edu LGA. They were divided into two halves; 60 women in a control group from one district and 60 women in an experimental group from the other district. The two districts were about 160 kilometers apart to try to control the exchange of information; however there was a possibility of exchanging information. The experimental group was delivered health messages related to delivery care services, while the control group was delivered health messages related to another topic; transmission and control of sexually transmitted infections. The sample of the study lacks the advantages of randomization that can affect the validity of the study; therefore it can be considered biased (Cuddeback, Wilson, Orme, & Combs-Orme, 2004).

The questionnaire is considered a practical way for assessing knowledge level, besides the comparison performed between the pre-intervention and post-intervention questionnaires seems quite sufficient for assessing the impact of health education on knowledge level of the targeted group. However, the researchers were faced by the problem of different languages; English is not the native language of these women. Also, another problem was that 30% of these women were illiterate. Consequently, these problems necessitated translation of the questionnaire into Nupe language and discussing the questions as an interview with illiterate subjects. The methods used for delivering the health messages were also fairly practical, as their variability suited with the demographic differences between the attendants. They used pamphlet, posters, video documentation and a delivery care services charts, in addition to permitting free discussion for clarification and answering any questions. Also, the researchers organized training workshops for health personnel working in local health centers such as nurses and community health educators from the targeted areas to help in the study as research assistants.

The results of the study rejected the first null hypothesis; health education intervention programme raised the knowledge level in the experimental group compared to the control group. On the other hand, the results accepted the second null hypothesis; health education intervention programme had no effect on willingness of the targeted group to seek delivery care services.

The authors recommended that Governmental and Non-governmental Organizations should work to intensify and strengthen the health messages about delivery care services, so as to maintain the knowledge gained from the health education intervention programme and increase the willingness of the women for utilizing the services. Moreover, they suggested using faith-based interventions to raise the awareness of the importance of such services among population, and pointed to the effect of education level on influencing the utilization of the services. These suggestions seem to be practical and applicable.

This research could have been improved in many ways. Randomization of the sample selection would have avoided the bias and increased the validity of the study. Besides, women alone do not decide to get the services especially in developing countries; they depend on their husbands and families for economic and logistical support to obtain the services (Moyer, Adongo, Aborigo, Hodgson, Engmann, & DeVries, 2014). Furthermore, all the targeted women had children, with 68% having 1-3 children. This fact increased the possibility of previous experiences of utilizing delivery care services. Usually, women prefer to give birth with the same provider if the previous delivery was satisfactory and change when they are unsatisfied (Paul & Rumsey, 2002). Subsequently, previously delivered service should have been assessed to discover any causes of rejection related to the service itself.

The article has been written clearly straight forward in an easy, understandable language, with clarification of abbreviations and sufficient explanation of the tables.

More researches can be conducted for improving the delivery care services especially in the developing countries. These researches may have many objectives to achieve such as assessment of the current service provided, identifying the factors that make the population reluctant to seek this service, raising concern among population about the importance of this service, and finally determination of the factors of satisfaction with the service.



This research is concerned with important health issues; maternal deaths, health education and health behavior of the population. The study had many limitations such as selection criteria of the sample, language barrier and ignorance barrier. However, the study was conducted efficiently relating to its nature as a quasi-experimental design.

The instrument used in the study, the questionnaire, was reliable and could answer the research questions. The methods used for delivering the health messages were effective, evidenced by increasing the knowledge level among the experimental group. The results of the study pay the attention to an essential issue; not only health education affects health behavior, but also many other demographic and cultural factors share in affecting health behavior of the population. However, this matter does not diminish the importance of health education as a contributing tool in solving many problems and modifying the health behavior.

Lowering the high maternal mortality in the developing countries requires co-operation between many official and social organizations. Also, more researches need to be done to gain more understanding of the problem, find out applicable solutions, suppose the action plan, and evaluate any trial carried out in reality.