Home / Current Issue / Paper 1723804
Applying the Health Belief Model to Explain Male Decision-Making on Childbirth Location in Rural Nigerian Communities
Subject area: Science,Engineering and Technology · Area of research: Public Health
Abstract
Background: Men often control household resources and influence decisions about where women give birth in rural Nigeria, yet their choices are rarely examined through a behavioural framework. Objective: This study applied the Health Belief Model (HBM) to explain how perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy shaped men’s support for facility-based childbirth. Methods: A theory-guided secondary interpretation was conducted using data from a concurrent triangulation mixed-methods study in rural communities of Akwanga, Keffi and Lafia Local Government Areas of Nasarawa State. The original study included a survey of 443 men, 12 focus group discussions, 70 key informant interviews, and 21 in-depth interviews. Quantitative findings were summarized descriptively and through reported chi-square associations, while qualitative themes were mapped to HBM constructs. Results: Although 95.3% of respondents were aware of safe delivery practices and 91.4% preferred facility delivery, cost was the leading reported barrier (74.7%). Cultural tradition, trust in traditional birth attendants, and lower cost continued to favour home delivery. Men recognized haemorrhage, infection, prolonged labour and death as serious outcomes, but previous uncomplicated home births reduced perceived susceptibility. Education was associated with knowledge of safe delivery (χ²=31.48, p=0.0001), occupation with attitudes toward home delivery (χ²=34.15, p=0.0072), and income with preferred delivery location (χ²=31.98, p=0.0011). Health workers, community leaders, prior complications, and health education acted as cues to action. Men’s capacity to mobilize money, transport and emergency support represented practical self-efficacy. Conclusions: The HBM explains an important part of male decision-making, particularly the gap between recognising the benefits of skilled attendance and acting when barriers are immediate. Its explanatory reach improves when household power, poverty, service quality and transport are treated as contextual forces rather than individual beliefs alone.
Keywords
childbirth location; facility-based delivery; Health Belief Model; male decision-making; maternal health; Nigeria
References
[1] Yargawa J, Leonardi-Bee J. Male involvement and maternal health outcomes: Systematic review and meta-analysis. Journal of Epidemiology and Community Health. 2015;69(6):604–612. https://doi.org/10.1136/jech-2014-204784
[2] Tokhi M, Comrie-Thomson L, Davis J, Portela A, Chersich M, Luchters S. Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions. PLOS ONE. 2018;13(1):e0191620. https://doi.org/10.1371/journal.pone.0191620
[3] Yaya S, Okonofua F, Ntoimo L, et al. Men’s perception of barriers to women’s use and access of skilled pregnancy care in rural Nigeria: A qualitative study. Reproductive Health. 2019;16:86. https://doi.org/10.1186/s12978-019-0752-3
[4] Okafor IP, Chukwudi CL, Igwilo UU, Ogunnowo BE. ‘Men are the head of the family, the dominant head’: A mixed-methods study of male involvement in maternal and child health in a patriarchal setting, Western Nigeria. PLOS ONE. 2022;17(10):e0276059. https://doi.org/10.1371/journal.pone.0276059
[5] Rosenstock IM. Historical origins of the health belief model. Health Education Monographs. 1974;2(4):328–335.
[6] Champion VL, Skinner CS. The health belief model. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: Jossey-Bass; 2008. p. 45–65.
[7] Nelson JR, Gren LH, Dickerson TT, et al. Using the Health Belief Model to explore rural maternal utilisation of skilled health personnel for childbirth delivery: A qualitative study in three districts of the Eastern Region of Ghana. Journal of Global Health Reports. 2021;5:e2021102. https://doi.org/10.29392/001c.29883
[8] Ajayi AI, Ahinkorah BO, Seidu AA. ‘I don’t like to be seen by a male provider’: Health workers’ strike, economic, and sociocultural reasons for home birth in settings with free maternal healthcare in Nigeria. International Health. 2023;15(4):435–444. https://doi.org/10.1093/inthealth/ihac064
[9] Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gülmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middle-income countries: A qualitative evidence synthesis. Reproductive Health. 2014;11:71. https://doi.org/10.1186/1742-4755-11-71
[10] Oguntunde O, Nyenwa J, Yusuf FM, et al. Factors associated with knowledge of obstetric danger signs and perceptions of the need for obstetric care among married men in northern Nigeria: A cross-sectional survey. BMC Pregnancy and Childbirth. 2019;19:123. https://doi.org/10.1186/s12884-019-2271-1
[11] Eze II, Ossai EN, Akamike IC, et al. Males’ perceptions and practices towards maternity care in rural southeast Nigeria: Policy implication of participatory action research for safe motherhood. PLOS ONE. 2023;18(3):e0282469. https://doi.org/10.1371/journal.pone.0282469
[12] Moyo E, Dzinamarira T, Moyo P, Murewanhema G, Ross A. Men’s involvement in maternal health in sub-Saharan Africa: A scoping review of enablers and barriers. Midwifery. 2024;133:103993. https://doi.org/10.1016/j.midw.2024.103993
[13] Ganle JK, Obeng B, Segbe J, Mwinyuri V. How intra-familial decision-making affects women’s access to, and use of maternal healthcare services in Ghana: A qualitative study. BMC Pregnancy and Childbirth. 2015;15:173. https://doi.org/10.1186/s12884-015-0590-4
[14] Gabrysch S, Cousens S, Cox J, Campbell OMR. The influence of distance and level of care on delivery place in rural Zambia: A study of linked national data in a geographic information system. PLOS Medicine. 2011;8(1):e1000394. https://doi.org/10.1371/journal.pmed.1000394
[15] Iliyasu Z, Abubakar IS, Galadanci HS, Aliyu MH. Birth preparedness, complication readiness and fathers’ participation in maternity care in a northern Nigerian community. African Journal of Reproductive Health. 2010;14(1):21–32.
How to cite this paper
@article{1723804,
author = {Dr. Abraham Ajigasokoa Ahmadu},
title = {Applying the Health Belief Model to Explain Male Decision-Making on Childbirth Location in Rural Nigerian Communities},
journal = {Iconic Research And Engineering Journals},
year = {2026},
volume = {10},
number = {4},
pages = {1322-1331},
issn = {2456-8880},
url = {https://www.irejournals.com/formatedpaper/1723804.pdf},
abstract = {Background: Men often control household resources and influence decisions about where women give birth in rural Nigeria, yet their choices are rarely examined through a behavioural framework.
Objective: This study applied the Health Belief Model (HBM) to explain how perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy shaped men’s support for facility-based childbirth.
Methods: A theory-guided secondary interpretation was conducted using data from a concurrent triangulation mixed-methods study in rural communities of Akwanga, Keffi and Lafia Local Government Areas of Nasarawa State. The original study included a survey of 443 men, 12 focus group discussions, 70 key informant interviews, and 21 in-depth interviews. Quantitative findings were summarized descriptively and through reported chi-square associations, while qualitative themes were mapped to HBM constructs.
Results: Although 95.3% of respondents were aware of safe delivery practices and 91.4% preferred facility delivery, cost was the leading reported barrier (74.7%). Cultural tradition, trust in traditional birth attendants, and lower cost continued to favour home delivery. Men recognized haemorrhage, infection, prolonged labour and death as serious outcomes, but previous uncomplicated home births reduced perceived susceptibility. Education was associated with knowledge of safe delivery (χ²=31.48, p=0.0001), occupation with attitudes toward home delivery (χ²=34.15, p=0.0072), and income with preferred delivery location (χ²=31.98, p=0.0011). Health workers, community leaders, prior complications, and health education acted as cues to action. Men’s capacity to mobilize money, transport and emergency support represented practical self-efficacy.
Conclusions: The HBM explains an important part of male decision-making, particularly the gap between recognising the benefits of skilled attendance and acting when barriers are immediate. Its explanatory reach improves when household power, poverty, service quality and transport are treated as contextual forces rather than individual beliefs alone.},
keywords = {childbirth location; facility-based delivery; Health Belief Model; male decision-making; maternal health; Nigeria},
month = {October},
}