Determinants of Healthcare Service Utilization among Undergraduates of Ignatius Ajuru University of Education, Nigeria.

Technical Summary: Determinants of Healthcare Service Utilization among Undergraduates of Ignatius Ajuru University of Education, Nigeria

Problem Statement
Despite the establishment of healthcare services within university communities to address the health needs of students and staff, utilization rates among undergraduate students in Nigeria remain suboptimal. The study identifies a complex interplay of factors contributing to this underutilization, including limited awareness of available services, negative attitudes from healthcare providers, financial constraints, accessibility issues, and cultural or religious belief systems. Specifically, the research highlights that in Ignatius Ajuru University of Education (IAUE), Port Harcourt, access to healthcare is often contingent on the payment of academic tuition fees, creating barriers for students who have not yet settled their fees. Furthermore, reported negative attitudes among healthcare workers and the influence of traditional belief systems on health-seeking behavior suggest that the current service delivery model is not fully effective. The study aims to empirically investigate the specific determinants—knowledge, attitude, socioeconomic status, availability, and belief systems—that influence healthcare service utilization among IAUE undergraduates.

Methodology
The research employed an institutional-based cross-sectional survey design to describe and evaluate phenomena without manipulating variables.

• Population and Sample: The study population consisted of 27,850 undergraduate students at IAUE. A sample size of 500 students was determined using the Taro Yamane formula.
• Sampling Technique: A multistage sampling technique was utilized. First, four faculties (Natural and Applied Sciences, Social Sciences, Administration/Management, and Humanities) were selected via simple random sampling. Second, four departments within each faculty were randomly selected. Finally, 32 students were systematically selected from each of the designated departments.
• Instrument: Data were collected using a self-developed instrument titled the Determinants of Healthcare Service Utilization Questionnaire (DHSUQ). The questionnaire comprised three sections: socio-demographic data (Section A), factors influencing utilization (Section B), and the extent of utilization measured on a four-point Likert scale (Always to Never) (Section C).
• Reliability: The internal consistency of the instrument was established using Cronbach's alpha, yielding a coefficient of 0.79, indicating acceptable reliability.
• Data Analysis: Data were analyzed using SPSS version 25.0. Inferential statistics, specifically Pearson Correlation, were used to test five null hypotheses at a 0.05 level of significance.

Key Results
The study tested five hypotheses regarding the relationship between specific determinants and healthcare service utilization. All null hypotheses were rejected, indicating statistically significant relationships (p < 0.05) for all variables, with significance values reported as 0.00* in the study tables:

1. Knowledge: A significant positive correlation was found between knowledge of health matters and service utilization (r = 0.44, p = 0.00*). Students with higher awareness of available services were more likely to utilize them.
2. Attitude: A significant positive correlation existed between the attitude of healthcare workers and utilization (r = 0.47, p = 0.00*). Positive provider attitudes were linked to higher utilization rates.
3. Socio-economic Status: A strong significant relationship was observed between socio-economic status and utilization (r = 0.72, p = 0.00*). Students with higher economic standing were more likely to access services compared to those with lower status.
4. Availability: The availability of healthcare facilities significantly influenced utilization (r = 0.56, p = 0.00*).
5. Belief System: A significant relationship was established between belief systems (religious and cultural) and utilization (r = 0.32, p = 0.00*).

Key Contributions
The paper contributes to the literature by providing empirical evidence from a Nigerian university context that healthcare utilization is a multifactorial phenomenon. It specifically isolates and quantifies the impact of five distinct variables on student health-seeking behavior. The study validates that utilization is not merely a function of need but is heavily mediated by:

• Institutional Factors: The physical availability of services and the professional conduct of staff.
• Individual Factors: The student's level of health literacy, economic capacity, and personal belief systems.
• Systemic Barriers: The linkage of healthcare access to tuition fee payment status, which disproportionately affects lower-income students.

Significance and Conclusions
The authors conclude that healthcare service utilization among undergraduates is significantly determined by knowledge, availability, provider attitude, belief systems, and socio-economic status. The study asserts that improving utilization requires a holistic, student-centered approach.

Based on these findings, the paper offers the following recommendations:

• University management must ensure the adequate availability of medical supplies and qualified personnel.
• Health promotion programs should be intensified to improve students' knowledge and attitudes toward healthcare.
• Stakeholders should promote traditional beliefs and customs that align with positive health-seeking behaviors.
• Government and university authorities should consider welfare packages, including free medical services or loans, to support students with low socio-economic status or those unable to pay tuition fees, thereby removing financial barriers to care.

The study emphasizes that without addressing these specific determinants, healthcare delivery in university settings will remain ineffective, particularly for the most vulnerable student populations.