Contextual influences on healthcare-seeking behavior of urban school-aged children in Nigeria: an application of the socioecological model

Abstract

School-aged children (5–17 years) constitute nearly 70% of Nigeria’s child population, yet hardly any child health legislation is enforced for this group, and their healthcare-seeking behaviors are seldom comprehensively evidenced in empirical studies. This study examined the multilevel factors influencing healthcare-seeking behaviors among school-aged children in an urban setting in Nigeria, using the socioecological model as an analytical framework. Data were collected across slums (poor, congested urban neighborhoods lacking amenities) and non-slums (well-off urban neighborhoods) through 39 in-depth interviews with school children, teachers, school administrators, policymakers, and program managers. We also conducted four sex-disaggregated focus group discussions with caregivers. Thematic analysis revealed a dynamic interplay of influences, ranging from child-level attributes such as age and gender to caregivers’ financial capacity and occupation. Broader cultural beliefs, religious practices, gaps in enforcement of existing child health legislation, and limited access to formal healthcare, often reinforced by negative and condescending attitudes from health workers, further encouraged unlawful and inappropriate healthcare-seeking behaviors by and for school-aged children. At the same time, although still largely unexplored, schools have emerged as promising platforms for fostering health awareness and supporting more informed healthcare among children. These findings highlight the need for culturally sensitive, legally binding health and child protection interventions that include school-based or school-linked health services, as well as a more responsive urban health system. Such measures are essential to encourage safer, more equitable healthcare-seeking behaviors among school-aged children.