Students’ perception of healthcare services and factors affecting their utilization at a Nigerian University: a cross-sectional study

Abstract

Healthcare service utilization among university students is critical for ensuring their health and academic success. This study was performed to determine the level of utilization as well as the perception and factors influencing the utilization of healthcare services by students at Afe Babalola University, Ado-Ekiti (ABUAD). This research involved a cross-sectional survey in which a semi-structured online questionnaire was used to collect data and a multistage sampling technique was used to sample the students. The students’ perceptions were converted to scores by summing their responses across the questions. The total score for each student was compared against the midpoint of the possible score range. Perceptions with a total score greater than or equal to 12.5 were categorized as positive, while those with a total score less than 12.5 were categorized as negative. Logistic regression analysis was used to identify predictors of healthcare service utilization. Utilization of healthcare services, the key outcome variable, was defined as the frequency with which students accessed available health services. All analyses were carried out using Statistical Product and Service Solutions (SPSS) software. A total of 429 students participated in this study, majority of whom were females (304, 70.9%), with a mean age of 18.9 ± 1.7 years. Three hundred and seventy-five students (87.4%) reported utilizing healthcare services at the university of which 186 (43.4%) reported to occasionally utilize healthcare services in the university. A total of 33.1% perceived that the attitude of staff was poor, while 12.6% strongly disagreed that the healthcare staff were incompetent. Overall, the majority (287, 66.9%) of the students had a negative perception of the utilization of healthcare services. Approximately 16% agreed that the high cost of drugs affects their utilization, while 35.9% agreed that the services provided were too expensive. Predictors of healthcare service utilization included being over 20 years old (AOR = 3.6, 95% CI: 1.1–11.6), study level, with fourth-year students having the highest likelihood of utilization (AOR = 13.8, 95% CI: 5.1–37.4), and positive perception of healthcare staff attitude (AOR = 2.5, 95% CI: 1.1–5.9). Students from lower-income families (< 200,000 Naira) were significantly more likely to utilize healthcare services (AOR = 39.2, 95% CI: 12.6–121.5). The study revealed that, despite widespread usage of healthcare services, students have a predominantly negative perception of these services. Key factors influencing healthcare utilization include age, study level, attitude of staff and family income. Addressing these barriers through targeted interventions can improve health outcomes and promote equitable access to quality healthcare.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-024-75573-0.

Introduction

Healthcare systems are designed to address the health needs of specific populations, requiring a robust funding mechanism, a skilled workforce, reliable information for decision-making, and well-equipped facilities. Optimal health is essential for a productive social and economic life, making effective and safe healthcare services crucial¹.

University students’ health services are vital given the global increase in tertiary enrollment². High-quality health services directly enhance students’ health and welfare and indirectly improve academic success³. Health issues can impact students’ learning, quality of life, and relationships both during their academic careers and after graduation, with potential long-term effects on their well-being and academic progress^4–11.

The utilization of health services is influenced by several factors: accessibility, quality of services, and client preferences, which are shaped by past experiences, beliefs, health status, and socioeconomic factors¹². Common health issues among university students, such as anxiety, depression, eating disorders, and substance abuse, pose significant challenges. Students who do not seek treatment are at higher risk of academic failure, substance abuse, and even suicide¹³. Research highlights that health issues negatively impact students’ learning, quality of life, and relationships, potentially leading to long-term consequences for their overall health and future success¹⁴.

In Nigeria, healthcare services are provided by the government, private organizations, and universities. However, utilization among university students is relatively low due to factors such as financial constraints, lack of awareness, and perceptions of service quality¹⁵. Additional factors, including religious beliefs, the cost of medical care, proximity to facilities, wait times, and service standards, also influence healthcare utilization¹⁶. High costs, unavailability of essential medications, long wait times, and insufficient referral services further affect service utilization at universities¹⁵.

In response to the growing demand for accessible healthcare in tertiary institutions, the Federal Government of Nigeria launched the Tertiary Health Institutions Social Health Insurance Programme (TISHIP), aimed at providing affordable healthcare to students in both public and private universities. Although TISHIP is not yet operational at Afe Babalola University, its implementation in other Nigerian universities offers a useful framework for assessing the utilization of healthcare services in future studies.

Research in Nigeria shows that individuals’ health-seeking behaviour and preferences shape their choice of healthcare facilities. For example, studies in Sagamu and Ilorin have identified private hospitals, teaching hospitals, patent medicine sellers, and maternity homes as preferred options due to factors like competence, effective treatment, prompt service, and overall service quality^17,18.

Despite the importance of healthcare services for university students, there is limited understanding of students’ perceptions and the factors influencing the utilization of healthcare services in Nigerian universities. Previous studies on healthcare utilization in Nigeria are relatively sparse and somewhat outdated^15,19,20.

This study aims to evaluate the perceptions and factors influencing the utilization of healthcare services among undergraduate students at Afe Babalola University (ABUAD). By doing so, it seeks to contribute significantly to the existing knowledge on healthcare utilization among university students in Nigeria and provide insights that could help improve healthcare services for this population.

Methods

Study area

The study was conducted at ABUAD, located in Ekiti state, specifically in Ado Ekiti town, which serves as the capital of Ekiti state in southwestern Nigeria. ABUAD is a prominent institution in Ekiti, boasting an average student population of 8000²¹. ABUAD is a private university in Nigeria known for its modern teaching facilities, including advanced e-learning platforms and electronic boards. The university is organized into six colleges, namely, the College of Medicine and Health Sciences, the College of Pharmacy, the College of Law, the College of Engineering, the College of Sciences, and the College of Social and Management Sciences, which offer a diverse range of undergraduate studies.

Complementing these academic resources is the Afe Babalola University Multisystem Hospital (AMSH), which provides comprehensive healthcare services to the university community. AMSH is staffed by a diverse cadre of healthcare professionals, including doctors, nurses, and support staff, who are dedicated to delivering high-quality medical care. The hospital operates round-the-clock, ensuring that students have access to healthcare services at any time, whether for emergencies or routine medical needs….

Research design

This study utilized a cross-sectional design and employed a descriptive survey approach to gather information.

Study population and duration

The research was conducted among undergraduate students at ABUAD from April to May 2023.

Inclusion and exclusion criteria

The study included undergraduates from selected colleges who expressed a willingness to participate. Conversely, individuals who did not complete the questionnaire during the study period were excluded from the research.

Sample size determination

The sample size was determined using the Taro Yamane (1973) formula²².

where.

n = Minimum sample size.

N = accessible population.

e = Level of significance = 0.05.

The sample size was determined using a formula based on a study population of 8000 participants, a desired significance level of ± 5%, and a 10% adjustment for potential nonresponse. The calculated sample size was 423.

Sampling technique

A multi-stage sampling technique was employed to select participants for the study:

Stage 1:

Computer-generated codes were used for a simple random sampling technique to select four out of the six colleges at ABUAD. The decision not to include higher-level sampling, such as faculties, was based on the university’s organizational structure, which comprises colleges and departments.

Stage 2:

Two departments were selected from each college using a simple random sampling technique of computer-generated codes. This method ensured that each department had an equal and unbiased chance of being selected.. This approach was taken because each college at ABUAD typically includes a minimum of two departments except the College of Law which has one department. Proportionate allocation was then used to determine the number of students to be sampled from each department based on their relative sizes within the college (Table 1). Within each department, students were randomly selected to participate in the study. This was done by assigning numbers to all students in the department and using a random number generator to select the required number of participants. The link to the online questionnaire was shared with the selected students from each department.

Table 1.

Proportionate allocation of sample size based on colleges and departments breakdown.

College	Department	Population	Calculated sample size
Medicine and Health Sciences	Public Health	66	15
Medicine and Health Sciences	Physiology	17	4
Engineering	Mechatronics	249	56
Engineering	Mechanical Engineering	190	42
Law	Law	1141	254
Social and Management Sciences	Media and Communication Studies	138	32
Social and Management Sciences	Business Administration	91	20
	Total	1892	423

To ensure the validity of responses, rigorous efforts were made to restrict the questionnaire’s access to eligible individuals and they include;

Access control:

The online questionnaire was distributed via a Google Forms link accessible only to students from the selected departments. Access was restricted to ensure that only eligible participants could respond.

Verification:

Participants were required to verify their student status before proceeding with the questionnaire, ensuring that only current ABUAD students were included in the study.

Response limits:

The Google Forms link was programmed to automatically stop accepting responses once the predetermined number of participants from each department was reached. This measure helped maintain sample integrity and data reliability.

Instrument for data collection

A 21-item semi-structured questionnaire was designed to address the study’s objectives. The survey comprised four sections: socio-demographics, utilization of healthcare services, students’ perceptions, and economic factors affecting healthcare utilization. The questionnaire included multiple-choice, Likert scale, and binary response questions.

The first section assessed the socio-demographics of the participants, gathering information on age, sex, marital status, and religion. Section B assessed the utilization of healthcare services among ABUAD students, using three questions that included yes/no and multiple-choice formats.Section C assessed the students’ perception towards the utilization of healthcare services. This section comprised 5 questions measured using a 4-point Likert scale, where “strongly agree” was the highest rank (assigned a score of 4) and “strongly disagree” was the lowest rank (assigned a score of 1). The students’ perceptions were quantified by summing their responses across five relevant questions. The possible total score for each student ranged from 5 (if a student selected “strongly disagree” for all questions) to 20 (if a student selected “strongly agree” for all questions). To categorize these perceptions into positive and negative, we compared the total score for each student against the midpoint of the possible score range, which is 12.5. Perceptions with a total score equal to or greater than 12.5 (more than 50% of the maximum possible score) were categorized as positive, while those with a total score less than 12.5 (less than 50% of the maximum possible score) were categorized as negative… The fourth section assessed the economic factors affecting the utilization of healthcare services among ABUAD students. A total of 3 questions were measured on a 4-point Likert scale. Strongly agree was the highest, and the strongly disagree was the lowest rank.

Validity and reliability

Content validity was ensured by academic staff in the Department of Public Health, Afe Babalola University. A pre-test involving 20 participants who were not part of the main sample was also conducted; the results yielded a Cronbach alpha reliability coefficient of 0.720, indicating good reliability.

Data collection and analysis

The self-administered online questionnaire was shared through selected departmental WhatsApp groups, and informed consent was obtained before participants accessed the survey. This ensured that only students from the selected departments could access the Google Forms link and participate in the study. Descriptive statistics were employed for categorical variables, and binary logistic regression analysis was used to assess the relationships between students’ perception and associated factors and between students’ perception and healthcare service utilization. Logistic regression was employed in this study to determine the influence of various social, perceptual, and economic factors on the utilization of healthcare services among students at Afe Babalola University. This statistical method is useful for modeling the relationship between a binary dependent variable (in this case, healthcare service utilization) and one or more independent variables (such as gender, family size, age, perceptions of healthcare services, and economic factors).

Steps in logistic regression analysis

Defining the dependent variable

The dependent variable in this analysis is the utilization of healthcare services, which is binary (0 = non-utilization, 1 = utilization).

The independent variables include:

Social factors

Gender, family size, and age.

Perception

Attitudes towards staff, distance of the facility, waiting time, and competence of healthcare staffs.

Economic barriers

Cost of services, ability to afford food, cost of drugs, family income, and monthly allowance.

Perception of healthcare services was defined through four key variables: attitudes towards staff, distance of the facility, waiting time, and competence of healthcare staff,. Each variable was measured using a Likert scale. Utilization of health services was defined as visiting the medical center at least once in the past six months. The individual variables were included in the logistic regression analysis to identify significant predictors of healthcare utilization.

In analyzing students’ perceptions of healthcare services, it was essential to focus on those who had actual experience with these services. Therefore, students who reported never utilizing the health services at the university medical center were excluded from the perception analysis. This exclusion ensures that the perception analysis accurately reflects the views of those with firsthand experience.

Perception factors considered students’ views on the attitude of healthcare staff, the distance of the facility from their hostel, waiting time, and staff competence. Economic barriers included students’ views on the affordability of services and food, the impact of high drug costs, family income across different brackets, and monthly allowances. Also, before the logistic regression analysis the responses of variables for perceptions and economic barriers were dichotomised into agree and disagree.

In our study, “economic barriers to utilization of health services” were assessed using three Likert scale questions. These questions asked participants to indicate their level of agreement (ranging from 1 = Strongly Disagree to 4 = Strongly Agree) with statements related to the financial aspects of accessing healthcare services.

For the purpose of the binary logistic regression analysis, we categorized the responses into two groups:

• “Agree” Category: This includes participants who selected “Agree” or “Strongly Agree.“.

• “Disagree” Category: This includes participants who selected “Disagree” or “Strongly Disagree.”

This binary categorization allowed us to create a dichotomous variable for each economic barrier question. In the regression model, we used “Agree” as the reference category. This means that the odds ratios generated from the regression analysis represent the likelihood of facing economic barriers (as defined by disagreement with the statements) compared to the reference group (those who agreed with the statements).

Statistical Product and Service Solutions (IBM SPSS) version 27 facilitated the data analysis, with the significance level set at 5%.

This study obtained ethical approval from the Afe Babalola University Health Research and Ethics Committee (ABUADHREC) before commencement, with the approval number ABUADHREC/19/05/2023/91. Informed consent was obtained from all subjects and/or their legal guardians, ensuring their voluntary participation. The study was conducted with a strict assurance of confidentiality for all information provided by the participants. Additionally, all methods were carried out in accordance with relevant guidelines and regulations, including the principles outlined in the Declaration of Helsinki.

Results

Sociodemographic data of the study participants

A total of 429 students participated in this study, most of whom were females (304, 70.9%) with a mean age of 18.95 ± 1.716 years (range: 14–27 years). The majority of the students (388; 90.4%) were Christians, while approximately 1% (5) were married. More than one-quarter (109) were in 200 level, while 53 students (12.4%) were 100 level. More information on the students’ demographics is summarized in Table 2.

Table 2.

Demographics of the study participants.

Variable		Frequency (n = 429)	Percent (%)
Age (Mean ± SD)		18.95 ± 1.716 years (Range: 14–27 years)
< 18 years		88	20.5
18–22 years		332	77.4
23 years and above		9	2.1
Gender	Male	125	29.1
	Female	304	70.9
Marital status	Single	424	98.8
	Married	5	1.2
Ethnicity	Yoruba	149	34.7
	Igbo	131	30.5
	Hausa	66	15.4
	Others	83	19.4
College	MHS	23	5.4
	SMS	49	11.4
	Law	256	59.7
	Engineering	101	23.5
Level of study	100 level	53	12.4
	200 level	109	25.4
	300 level	101	23.5
	400 level	96	22.4
	500 level	70	16.3
Religion	Christianity	390	90.9
	Islam	39	9.1
Family size	< 4 persons	52	12.1
	4–6 persons	272	63.4
	> 6 persons	105	24.5
Student Monthly Allowance (Naira)	20,000–50,000	170	39.6
	60,000-100,000	191	44.5
	> 100,000	68	15.9
Family Monthly Income (Naira)	< 200,000	59	13.8
	200,000-500,000	144	33.6
	600,000–1,000,000	164	38.2
	> 1,000,000	62	14.5

Key: SD: Standard Deviation; MHS: Medicine and Health Sciences; SMS: Social and Management Sciences; Others: These includes other ethnic groups of the students including Ibibio, Efik, Kalabari and Itsektiri.

Utilization and frequency of utilization of healthcare services by ABUAD students

Three hundred and seventy five (87.4%) students reported utilizing healthcare services at the university (Fig. 1). Over 49% (186) reported using the services occasionally, while 4% (17) stated that they use the services monthly within a session (Fig. 2).

Fig. 1.

Utilization of healthcare services by ABUAD students.

Fig. 2.

Frequency of healthcare services utilization.

Students’ reasons for utilizing healthcare services

The majority of the students (319, 85.1%) stated that they visited or utilized healthcare services when they had symptoms of illness, such as headache and fever, while 11.2% (42) stated that they had visited due to accidents/injuries. Other reasons for visits included mental health services (13, 3.5%), sexual/reproductive health (13, 3.5%), and communicable diseases (15, 4%) (Fig. 3)

Fig. 3.

Student reasons for utilization of healthcare services.

Students’ perception of the utilization of healthcare services

In this study, 48.0% (180) of the students disagreed that they felt that the attitude of the staff was poor, while 2.4% (9) strongly disagreed that the distance of the facility was too far from the student hostels. Most of the students (68.0%, 255) disagreed that the healthcare staff were incompetent, while more than 50% felt that the waiting time was too long. Overall, the majority (248, 66.1%) of the students had negative perception toward the utilization of healthcare services while about 34% had positive perception. These data are summarized in Table 3.

Table 3.

Perception of the students toward the utilization of healthcare services.

S/N	Statements	Responses (%) (N = 375)
		SA	A	D	SD
1.	Attitude of the staff is poor	44 (11.7)	121 (32.3)	180 (48.0)	30 (8.0)
2.	Distance of the facility from the hostel is too far	215 (57.3)	113 (30.1)	38 (10.1)	9 (2.4)
3.	Healthcare staff are incompetent	15 (4.0)	56 (14.9)	255 (68.0)	49 (13.1)
4.	Waiting time is too long	132 (35.2)	167 (44.5)	63 (16.8)	13 (3.5)
5.	I am not satisfied with the services provided	51 (13.6)	99 (26.4)	188 (50.1	37 (9.9)
	Positive Perception	127 (33.9)
	Negative Perception	248 (66.1)

Key: SA = Strong Agree-1; A = Agree-2; D = Disagree-3; SD = Strongly Disagree-4.

Economic barriers to utilization of healthcare services among ABUAD students

Approximately 16% reported that the high cost of drugs has affected their utilization of healthcare services, while 35.9% (154) stated that the services provided are too expensive. The majority of the students (265, 61.8%) at least disagreed that not being able to afford food at school affected their ability to utilize healthcare services (Table 4).

Table 4.

Economic barriers to utilization of healthcare services among ABUAD students.

S/N	Statements	Responses (%) (N = 429)
		SA	A	D	SD
1.	High cost of drugs has affected my utilization of healthcare services in ABUAD	68 (15.9)	102 (23.8)	206 (48.0)	53 (12.4)
2.	The services provided are too expensive	110 (25.6)	154 (35.9)	138 (32.2)	27 (6.3)
3.	I can barely afford food in school and that has affected my ability to utilize healthcare services	81 (18.9)	83 (19.3)	190 (44.3)	75 (17.5)

Key: SA = Strong Agree-1; A = Agree-2; D = Disagree-3; SD = Strongly Disagree-4.

Association between factors and utilization of healthcare services among university students

Gender did not significantly affect utilization, with 108 males (86.4%) and 267 females (87.8%) utilizing healthcare services, compared to 17 males (13.6%) and 37 females (12.2%) who did not (χ² = 0.164, p = 0.149).

The level of study showed a significant association with healthcare utilization (χ² = 25.094, p < 0.001). Utilization rates increased with the level of study, with the highest rates among 400 and 500 Level students. Family size did not have a significant impact on healthcare utilization (χ² = 0.042, p = 0.179) but family monthly income was a significant factor (χ² = 56.202, p < 0.001). Age also significantly influenced utilization (χ² = 4.821, p = 0.036), with younger students (< 20 years) utilizing services more frequently than older students (> 20 years). Also, high cost of drugs (χ² = 51.887, p < 0.001) and expensive services (χ² = 4.101, p = 0.050) were significantly associated to utilization. The attitude of healthcare staff significantly affected utilization (χ² = 8.218, p = 0.005) while factors such as the distance to the facility (χ² = 0.008, p = 0.100), competence of staff (χ² = 1.453, p = 0.172), long waiting times (χ² = 2.456, p = 0.154), and overall satisfaction with services (χ² = 1.295, p = 0.301) did not significantly impact utilization. This has been summarized in Table 5.

Table 5.

Factors affecting utilization of health services.

Variable		Utilization of healthcare services		χ2	p-valuea
		Yes N (%)	No N (%)
Gender	Male	108 (86.4%)	17 (13.6%)	0.164	0.149
	Female	267 (87.8%)	37 (12.2%)
Level of Study	100 Level	37 (69.8%)	16 (30.2%)	25.094	< 0.001*
	200 Level	9 (87.2%)	14 (12.8%)
	300 Level	85 (84.2%)	16 (15.8%)
	400 Level	92 (95.8%)	4 (4.2%)
	500 Level	66 (94.3%)	4 (5.7%)
Family size	< 4 persons	45 (86.5%)	7 (13.5%)	0.042	0.179
	4–6 persons	238 (87.5%)	34 (12.5%)
	> 6 persons	92 (87.6%)	13 (12.4%)
Student monthly allowance	20,000–50,000	150 (88.2%)	20 (11.8%)	0.952	0.145
	60,000-100,000	168 (87.9%)	23 (12.1%)
	> 100,000	57 (83.8%)	11 (16.2%)
Family monthly income	< 200,000	58 (98.3%)	1 (1.7%)	56.202	< 0.001*
	200,000-500,000	136 (94.4%)	8 (5.6%)
	600,000–1,000,000	144 (87.8%)	20 (12.2%)
	> 1,000,000	37 (59.7%)	25 (40.3%)
Age	< 20 years	301 (85.8%)	50 (14.2%)	4.821	0.036*
	> 20 years	74 (94.9%)	4 (5.1%)
#High cost of drugs	Agree	81 (72.3%)	31 (27.7%)	51.887	< 0.001*
	Disagree	70 (33.6%)	138 (66.4%)
#Services too expensive	Agree	224 (84.8%)	40 (15.2%)	4.101	0.050*
	Disagree	151 (91.5%)	14 (8.5%)
#Affordability of food	Agree	138 (84.1%)	26 (15.9%)	2.574	0.134
	Disagree	237 (89.4%)	28 (10.6%)
#Attitude of staff	Agree	165 (82.5%)	35 (17.5%)	8.218	0.005*
	Disagree	210 (91.8%)	19 (8.2%)
#Distance of facility	Agree	328 (87.5%)	47 (12.5%)	0.008	0.100
	Disagree	47 (87.0%)	7 (13.0%)
#Perceived incompetence of healthcare staff	Agree	71 (83.5%)	14 (16.5%)	1.453	0.172
	Disagree	304 (88.4%)	40 (11.6%)
#Long waiting time	Agree	299 (88.7%)	38 (11.3%)	2.456	0.154
	Disagree	76 (82.6%)	16 (17.4%)
#Services not satisfactory	Agree	150 (85.2%)	26 (14.8%)	1.295	0.301
	Disagree	225 (88.9%)	28 (11.1%)

Key: Dependent variable = Utilization of Healthcare services; ^a= Chi-square test; *= Statistically significant at p ≤ 0.05; #= The Likert scale responses for economic barriers and perception variables were dichotomized to Agree and Disagree.

Regression analysis between demographic variables, perception, economic factors, and utilization of healthcare services among the students

In the logistic regression analysis, the dependent variable was the utilization of healthcare services among students. The analysis assessed the impact of social, perception-related, and economic barriers (independent variables) on this utilization. Each factor’s effect was measured using adjusted odds ratios (AOR) with 95% confidence intervals (CI) and corresponding p-values to determine statistical significance. Compared with males, females were 1.723 times more likely to have utilized university healthcare services, but was not statistically significant (p = 0.164; AOR = 1.723 (0.800-3.709)). Students aged > 20 years were 3.607 times more likely to utilize healthcare services than students aged less than 20 years were. (p = 0.031; AOR = 3.607 (1.123–11.590)). There was an increased likelihood of utilization among second-year students (OR = 5.055; (p = 0.001)), third-year students (AOR = 4.203; (p = 0.005)), fourth-year students (AOR = 13.811; (p < 0.001), and fifth-year students (AOR = 6.928; (p = 0.024)) compared to first-year students.

Students who disagreed that the attitude of healthcare staff was poor had higher odds of utilizing services (AOR = 2.507, p = 0.032). Family income was a critical predictor of healthcare service utilization. Students from families earning less than 200,000 Naira had a likelihood of 39.2 (95% CI: 5.091–301.7, p < 0.001) for utilizing healthcare services. Those from families with incomes between 200,000 and 500,000 Naira had a likelihood of 11.5 (95% CI: 4.8–27.6), p < 0.001), while students from families earning between 600,000 and 1,000,000 Naira had a likelihood of 4.9 (95% CI: 2.4–9.7, p < 0.001) compared to students from families earning more than 1,000,000 Naira.

Non-significant factors included gender (AOR = 1.723, p = 0.164), family size of 4–6 persons (AOR = 0.721, p = 0.558), and more than 6 persons (AOR = 0.710, p = 0.591). Disagreement with statements about the distance to the facility being too far (AOR = 0.797, p = 0.675), waiting time being too long (AOR = 0.591, p = 0.253), and high cost of drugs (AOR = 1.770, p = 0.178) did not significantly impact utilization. These data are summarized in Table 6.

Table 6.

Predictors of health service utilization.

Independent Variable	Category	AOR (95% CI)	p-valuea
Gender	Female (ref: Male)	1.723 (0.800-3.709)	0.164
Family Size	4–6 persons (ref: <4 persons)	0.721 (0.242–2.150)	0.558
	More than 6 persons (ref: <4 persons)	0.710 (0.204–2.475)	0.591
Age	> 20 years (ref: <20 years)	3.607 (1.123–11.590)	0.031*
Study Level	200 Level (ref: 100 Level)	5.055 (1.895–13.484)	0.001*
	300 Level (ref: 100 Level)	4.203 (1.549–11.403)	0.005*
	400 Level (ref: 100 Level)	13.811 (3.537–53.933)	< 0.001*
	500 Level (ref: 100 Level)	6.928 (1.289–37.225)	0.024*
#Attitude of Staff is Poor	Disagree (ref: Agree)	2.507 (1.084–5.796)	0.032*
#Distance from Facility too far	Disagree (ref: Agree)	0.797 (0.275–2.306)	0.675
#Waiting Time too long	Disagree (ref: Agree)	0.591 (0.239–1.458)	0.253
#Perceived incompetence of Healthcare Staff	Disagreed (ref: Agreed)	1.299 (0.535–3.155)	0.563
#Cost of Services too expensive	Disagree (ref: Agree)	1.057 (0.438–2.551)	0.902
#Affordability of Food affecting utilization	Disagree (ref: Agree)	1.208 (0.556–2.624)	0.634
#High Cost of Drugs affects utilization	Disagree (ref: Agree)	1.770 (0.772–4.057)	0.178
Family Income (Naira)	< 200,000 (ref: >1,000,000)	39.189 (5.091-301.653)	< 0.001*
	200,000-500,000 (ref: >1,000,000)	11.486 (4.788–27.559)	< 0.001*
	600,000–1,000,000 (ref: >1,000,000)	4.865 (2.440–9.700)	< 0.001*
Monthly Allowance (Naira)	60,000-100,000 (ref: 20,000–50,000)	1.051 (0.485–2.278)	0.899
	> 100,000 (ref: 20,000–50,000)	0.806 (0.281–2.308)	0.687

Key: Dependent variable = Utilization of Healthcare services; OR = Odds Ratio; CI = Confidence interval; ^a= Logistic regression; *= Statistically significant at p ≤ 0.05; Ref: Reference value; #= The Likert scale responses for economic barriers and perception variables were dichotomized to Agree and Disagree. Note: A cutoff p-value of < 0.2 was used to include variables into the binary logistic regression model after bivariate analysis.

Discussion

The aim of this study was to explore the perception of students and identify the factors affecting the utilization of healthcare services among undergraduate students at Nigerian University. The findings provide valuable insights into the dynamics of healthcare utilization and highlight key areas that need attention to improve the healthcare experience for students.

Healthcare utilization refers to the frequency with which individuals use healthcare services, a factor that varies widely among people and is influenced by various determinants²³. In this study, a notable 87.4% of students reported utilizing healthcare services, surpassing the 48.7% reported in a similar study across Nigeria²⁰. This higher utilization rate can be attributed to several key factors.

Firstly, the accessibility and availability of healthcare services play a crucial role. When healthcare facilities are easily accessible and conveniently located, individuals are more likely to seek medical care promptly, thereby increasing utilization rates²⁴. Secondly, effective awareness campaigns and information dissemination about healthcare services at ABUAD would have likely contributed to students’ heightened knowledge and awareness of available healthcare options. Well-informed individuals are more inclined to recognize the benefits of seeking timely medical assistance when needed²⁵.

Additionally, the perceived quality of healthcare services is a significant determinant of utilization rates. Positive experiences with healthcare providers, including perceptions of care quality, efficiency, and overall satisfaction, can encourage students to utilize these services more frequently²⁶. Students’ perception of the healthcare services as reliable and of high quality could explain their greater propensity to utilize them compared to other settings.

Furthermore, cultural and socioeconomic factors also influence healthcare utilization patterns. Variations in beliefs about healthcare, financial constraints, and trust in the healthcare system can impact individuals’ decisions to seek medical care. These factors differ among populations and regions within Nigeria, contributing to varying healthcare utilization rates across the country²⁷. Understanding these dynamics is crucial for designing interventions that promote equitable access to quality healthcare and improve health outcomes across diverse populations.

The students identified reasons for utilization of healthcare services to include malaria, accidents/injuries, mental health illnesses, sexual and reproductive health issues, and symptoms such as headache, cough, diarrhea, and body pains. This finding is similar to findings in Nigeria, where malaria/fever (40%), abdominal complaint (100%), dysentery/diarrhea (46.2%) and respiratory tract infection (22.2%) were the identified reasons for utilization of healthcare by the students²⁰. The majority of the students reported symptoms such as headache, abdominal pain, diarrhea, and fever, which are common illnesses that affect young students in tertiary institutions. However, a small number of students reported visiting healthcare facilities due to mental health issues, similar to the findings in Ado-Ekiti, Nigeria²⁸. This could be due to the stigma associated with mental health illnesses.

The majority of the students in this study had negative perception toward the utilization of healthcare services, and poor attitudes toward staff, long waiting times, and long distances from the facility were common reasons provided by the students. This finding aligns with that of a study carried out in a tertiary institution in South‒West South-West Nigeria, where time spent waiting (67.2%), satisfaction with services (60.2%), and accessibility of facilities (74.3%) were identified as reasons for poor utilization of services by the students¹⁵. These reasons are probably related to the establishment and provision of healthcare services in the facility. These results also agreed with the findings among students in a university in Ife, Nigeria²⁷. Perceptions of healthcare costs, particularly the high cost of drugs and service expenses, significantly influenced utilization rates among ABUAD students. These findings are consistent with a study in Nigeria emphasizing that financial barriers and perceived high costs are major deterrents to healthcare service utilization among young adults¹⁵. Moreover, the study highlighted the impact of healthcare staff attitudes on utilization, with poor staff attitudes correlating with higher non-utilization rates. This underscores the critical role of interpersonal factors in shaping healthcare-seeking behaviors among students²⁹.

Factors such as distance to the healthcare facility, competence of staff, waiting times, and overall satisfaction with services did not significantly influence utilization rates among ABUAD students. These findings diverge from some literature suggesting that geographic accessibility³⁰, service quality³¹, and patient satisfaction²⁶ play pivotal roles in healthcare utilization decisions. The lack of significant associations in these areas in this study may reflect unique institutional dynamics or student perceptions that differ from broader trends observed in healthcare utilization research.

In this study, a number of social factors were explored to assess their influence on the utilization of healthcare services among the students.

The study found no significant gender-based differences in healthcare utilization, consistent with several studies that suggest gender, though important, may not be the only decisive factor in healthcare-seeking behaviors among university students^28,32,33. However, females generally exhibit better health-seeking behavior than males, as reported in other studies^34,35.

The significant association between the level of study and utilization rates suggests that as students’ progress academically, they tend to utilize healthcare services more frequently. This trend aligns with findings OECD countries indicating that increased health awareness and evolving health needs as students advance academically contribute to higher healthcare utilization²⁵.

With respect to age, Students aged over 20 years had a higher likelihood of utilizing healthcare services than those younger than 20 years. This finding was similar to results obtained in Brazil, where older students were more likely to utilize healthcare services³². Older individuals often have higher health consciousness and awareness, contributing to their increased utilization of healthcare services³³.

Family income emerged as a critical determinant of healthcare utilization among ABUAD students, with lower-income families exhibiting higher utilization rates. This finding corroborates extensive literature demonstrating that financial constraints significantly hinder healthcare access and utilization among student populations³⁶. Conversely, family size and student monthly allowance did not significantly influence utilization in this study, which contrasts with some studies suggesting that larger family sizes or lower allowances may affect healthcare-seeking behaviors negatively³⁷.

Financial constraints were also identified as a significant factor affecting healthcare utilization. Students who reported financial difficulties such as expensive services and high costs of drugs were less likely to utilize healthcare services than were those who did not face financial constraints. This finding aligns with a study performed in Nigeria in which community members who reported the cost of health services at healthcare facilities to be affordable were twice as likely to utilize the services than were those reporting health service costs as unaffordable³⁸. Other studies have also highlighted the impact of financial barriers on healthcare access and utilization^39–41. Additionally, students with lower family incomes were generally more likely to utilize healthcare services than were those without such income. This finding was similar to that reported in a Federal Institution in South West Nigeria where students with low incomes used health centers substantially more than other students did²⁰. A possible explanation for this could be that students with a lower income had more need to utilize the services than did those with more income. The increased likelihood of accessing healthcare services shown by the students in this study could be due to the readily available resources for healthcare.

Limitations of the study

This study was carried out at one center, which may affect generalizability. The findings may not be applicable to university students in other countries with different healthcare systems and cultural contexts. However, this approach provides a good platform for other studies. There may be other factors affecting healthcare utilization among university students that were not measured in this study. Another notable limitation of this study is the absence of TISHIP at Afe Babalola University at the time of data collection. The lack of this social health insurance program may have influenced students’ perception of healthcare services and their utilization patterns. Future studies could compare these results with those from universities where TISHIP is operational, to better understand the impact of social health insurance on students’ healthcare-seeking behavior.

Conclusion

The study findings highlight significant insights into healthcare service utilization among students at Afe Babalola University, Ado-Ekiti (ABUAD). Despite a majority of students utilizing healthcare services, there exists a prevalent negative perception among them. Factors such as age, study level and family income significantly influenced healthcare utilization patterns among the students. Addressing these barriers through targeted interventions can improve health outcomes and promote equitable access to quality healthcare services. Future research should continue to explore these factors in different populations and settings to inform effective healthcare policies and practices.

Public health implications

The findings have several public health implications. First, there is a need for university administrations and policymakers to implement strategies that reduce financial barriers to healthcare access for students, such as subsidized health insurance or lower-cost services. Second, interventions aimed at improving the perception of healthcare quality, including staff training and better service delivery, could enhance utilization rates. Lastly, targeted outreach and health promotion activities for students in higher study levels and those from economically disadvantaged backgrounds are crucial to ensure equitable access to healthcare. By addressing these factors, universities can foster a healthier student population, leading to improved academic performance and overall well-being.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

ABUAD

Afe Babalola University Ado-Ekiti

ABUADHREC

Afe Babalola University Health Research Ethics Committee

WHO

World Health Organization

Author contributions

EO, SN and OK conceptualized the study. EO analyzed and interpreted the patient data. SN collected the data from the patients. OO, TO, TOL, BJ, TB, AA, and TA reviewed the manuscript. All authors approved the final version of the manuscript.

Funding

The authors did not receive any form of external funding for this research.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This study obtained ethical approval from the Afe Babalola University Health Research and Ethics Committee (ABUADHREC) before commencement, with the approval number ABUADHREC/19/05/2023/91. Informed consent was obtained from all subjects and/or their legal guardians, ensuring their voluntary participation. The study was conducted with a strict assurance of confidentiality for all information provided by the participants. Additionally, all methods were carried out in accordance with relevant guidelines and regulations, including the principles outlined in the Declaration of Helsinki.

Competing interests

The authors declare no competing interests.