<b>Effect of community-based social–behavioural intervention on determinants of maternal care-seeking for under-five children in Cross River State, Nigeria</b>

Abstract

Introduction: Under-five morbidity and mortality remain high in sub-Saharan Africa, partly due to poor maternal care-seeking. Despite improved healthcare access, behavioural and social barriers still delay timely care for childhood illnesses. This study assessed the effect of a community-based behavioural intervention on determinants of maternal care-seeking in Cross River State, Nigeria. Methods: A quasi-experimental design guided by the PRECEDE–PROCEED model was used. Sixty mothers were selected through a multi-stage sampling process and assigned to either an intervention or control group. The four-week intervention consisted of knowledge and skills training, as well as behaviour change communication, delivered via community information booths. Data were collected at baseline and week ten using a validated interviewer-administered questionnaire assessing predisposing, enabling, and reinforcing factors. Between-group differences were analysed using independent t-tests and Multivariate Analysis of Covariance (MANCOVA) (p < 0.05), and Cohen’s d estimated effect sizes. Results: Although the sample size was small (N=60), statistically significant improvements were observed. The MANCOVA indicated a strong multivariate effect (Pillai’s Trace = .876, p < .001), indicating that 87.6% of the variance in outcomes was attributable to group assignment. Univariate analyses showed significant improvements in knowledge (F = 68.21, p < 0.001, η² = 0.58), attitude (F = 15.33, p < 0.001, η² = 0.24), perception (F = 168.27, p < 0.001, η² = 0.77), and reinforcing factors (F = 168.22, p < 0.001, η² = 0.77). Enabling factors did not differ significantly between groups. Conclusion: The intervention improved determinants of maternal healthcare-seeking for children under five.