Patterns of health-seeking behaviour and their association with proximity to National Health Insurance Scheme-accredited facilities among undergraduates in south-western Nigeria: a multicentre cross-sectional study

When a person feels unwell, the path to recovery is rarely a straight line. It is a journey shaped by what is available, what can be afforded, and what the individual believes will work. In many parts of the world, this journey often splits between two worlds: the formal medical system, with its doctors and hospitals, and the informal network of neighbors, herbalists, and self-prescribed remedies. For young adults, particularly university students, these choices are critical. This group is often healthy, yet they face unique pressures that can lead them to ignore symptoms or treat themselves without professional guidance. Understanding how they navigate these options is vital, because the habits formed during these years often set the tone for a lifetime of health decisions. A key question for health planners is whether simply having a hospital nearby is enough to get people to walk through its doors, or if other factors, like how long they have to wait or how they are treated, matter more.

Researchers in southwestern Nigeria set out to answer this question by looking closely at the health choices of university students. They focused on four major federal universities in the region, surveying nearly four hundred undergraduates to map out their behavior when sickness struck. The team wanted to know if living close to a facility accredited by the National Health Insurance Scheme—a program designed to make healthcare affordable and accessible—actually changed how students sought help. They also examined what drove students toward informal care, such as buying medicine from street vendors or relying on spiritual practices, versus seeking help from a qualified doctor. The study revealed a complex picture where proximity was not the deciding factor, and where the daily experience of care mattered far more than the distance to the clinic.

The survey found that the vast majority of students, about ninety percent, had experienced some form of illness or symptom while at school. When these symptoms appeared, the students did not stick to a single path. Instead, they often moved between different types of care. It was common for a student to rest and do nothing, to take medicine they bought themselves, or to consult a patent medicine vendor, which is a licensed seller of over-the-counter drugs. Many also turned to the internet or colleagues for advice. Despite this heavy reliance on informal methods, more than half of the students still visited a formal hospital when they were sick. This suggests a pattern of switching, where a student might try a quick fix first and then go to a doctor if the problem did not go away, or if the pain became too much to bear.

The reasons behind these choices were revealing. When students chose informal care, such as buying drugs from a vendor or using herbs, the most powerful driver was accessibility. They chose these options because they were easy to reach and quick to use, not necessarily because they were cheaper. For instance, nearly eighty percent of those who bought drugs from vendors did so because the vendor was accessible, while only a small fraction cited cost as the main reason. Similarly, when students chose to rest or do nothing, it was usually because they believed their symptoms were not serious enough to warrant a doctor's visit. Shyness or a lack of knowledge about where to go played a very minor role, which contradicts the idea that students avoid doctors simply because they are embarrassed or confused.

When students did decide to go to a formal hospital, their reasons were different. They were encouraged by the belief that the treatment would work and that their symptoms were serious. However, the barriers were just as clear. The biggest deterrents were the quality of service they expected to receive, the long waits they feared, and the availability of necessary drugs. Interestingly, the distance to the hospital did not seem to matter as much as these practical concerns. The study specifically tested whether being closer to a National Health Insurance Scheme-accredited facility made students more likely to use formal care. The data showed no significant link between living near such a facility and actually visiting it. Whether a student lived on campus or off campus, their likelihood of seeking formal care remained the same.

The study also looked at how much students knew about their university's health insurance scheme. While a little more than half of the students were aware that such a scheme existed, very few understood the details, such as how much they paid or what costs were covered. This lack of knowledge meant that the insurance itself was not a strong motivator for seeking care. In fact, among those who knew about the scheme, the most common reason for not using the university health center was the long waiting time. Even though the insurance was meant to make care easier, the experience of waiting in line was enough to discourage students from using it.

The researchers found that certain factors did influence behavior, but not the ones related to location. Students in their final years of study were more likely to visit a hospital than those in their second year, and the type of religion a student practiced also played a role. However, the physical presence of a nearby accredited facility did not change the outcome. The findings suggest that for young people, the convenience and quality of the service are far more important than the distance to the clinic. Simply placing a hospital on a map or ensuring it is nearby is not enough to change behavior.

Ultimately, the study points to a need for a shift in how healthcare is delivered to students. If the goal is to encourage more young people to seek formal medical help, the focus must move beyond just building facilities or expanding insurance coverage. The real solution lies in improving the experience of care itself. This means reducing waiting times, ensuring that essential medicines are always in stock, and training staff to be competent and courteous. When formal care becomes fast, reliable, and respectful, it becomes a more attractive option than the informal alternatives. The presence of insurance is only useful if the system it supports is efficient enough to be worth using. For the students in this study, and likely for many others, the path to health is determined not by how far they have to walk, but by how well they are treated when they arrive.