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Influence of Hepatitis B Awareness on Hepatitis B Testing Practices among University Students in Nigeria

Abstract

Hepatitis B virus (HBV) infection remains an important public health concern in Nigeria and can lead to chronic liver disease, cirrhosis, liver cancer, and other serious health complications. University students represent an important population for hepatitis B prevention because young adults may encounter risk factors such as unprotected sexual exposure, contact with infected blood or body fluids, non-sterile procedures, and inadequate knowledge of hepatitis B transmission and prevention. Hepatitis B awareness provides students with information about the causes and modes of transmission of HBV infection, signs and symptoms, risk factors, vaccination, prevention, testing, treatment, and the importance of knowing one's hepatitis B status. Hepatitis B testing practices refer to behaviours related to seeking and utilizing appropriate hepatitis B testing services, including voluntary testing, testing following potential exposure, and follow-up testing where recommended. In Nigeria, inadequate awareness, misconceptions, perceived low personal risk, fear of a positive result, stigma, cost, and limited access to testing services may discourage university students from utilizing hepatitis B testing. Effective hepatitis B awareness may improve students' knowledge and risk perception and encourage appropriate testing practices. Against this background, this study investigates the influence of hepatitis B awareness on hepatitis B testing practices among university students in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and Knowledge-Attitude-Practice framework. The Health Belief Model explains health-screening and testing behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding students' decisions to utilize hepatitis B testing services. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, behavioural capabilities, and environmental conditions in shaping health behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from hepatitis B awareness may influence testing practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how hepatitis B awareness may influence hepatitis B testing practices among university students in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from undergraduate students in selected universities in Nigeria using a structured anonymous self-administered questionnaire and, where feasible, verification of hepatitis B testing through voluntary health-service records with appropriate confidentiality safeguards. A multistage sampling technique will be employed to select states, universities, faculties or departments, academic levels, and eligible students. Where feasible, selected student groups will be assigned to intervention and comparison groups. Students in the intervention group will receive structured hepatitis B awareness education covering HBV transmission, symptoms, risk factors, prevention, vaccination, testing, treatment options, misconceptions, stigma, and the importance of knowing one's hepatitis B status. Hepatitis B testing practices will be assessed using indicators such as previous hepatitis B testing, willingness to undergo testing, intention to utilize testing services, utilization of available testing facilities, testing following identified risk or potential exposure, and compliance with recommended follow-up testing where applicable. Descriptive statistics will be used to summarize students' sociodemographic characteristics, hepatitis B awareness, exposure to education, and testing practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the influence of hepatitis B awareness on hepatitis B testing practices. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that hepatitis B awareness has a significant positive influence on hepatitis B testing practices among university students in Nigeria. Students exposed to structured hepatitis B awareness education are expected to demonstrate improved knowledge of HBV transmission, risk factors, prevention, vaccination, testing, and treatment. Education may improve perceived susceptibility, reduce misconceptions and stigma, increase awareness of testing services, and encourage students to undergo hepatitis B testing when appropriate. Early knowledge of hepatitis B status may also support timely linkage to appropriate healthcare, vaccination of susceptible individuals, and prevention of further transmission. However, awareness alone may not guarantee increased testing because students may continue to face barriers such as cost, limited availability of testing facilities, concerns about confidentiality, fear of a positive result, stigma, inconvenience, and inadequate knowledge of where testing services are available. Consequently, hepatitis B awareness is expected to be most effective when supported by accessible and confidential testing services, affordable healthcare, vaccination programmes, appropriate counselling, and effective university health services. The study is expected to contribute to the literature on hepatitis B prevention, health education, infectious disease testing, university health, vaccination, and public health in Nigeria by providing empirical evidence on the influence of hepatitis B awareness on hepatitis B testing practices among university students. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention (NCDC), National Primary Health Care Development Agency (NPHCDA), National Universities Commission, university health services, healthcare providers, public health practitioners, development partners, and policymakers regarding strategies for improving hepatitis B detection and prevention among young adults. The study will also provide evidence-based recommendations for strengthening university-based hepatitis B awareness programmes, expanding accessible and confidential testing services, improving vaccination awareness and uptake, reducing stigma and misconceptions, strengthening health counselling, and promoting appropriate hepatitis B testing practices among university students across Nigeria.

Keywords: Hepatitis B awareness, hepatitis B testing practices, university students, hepatitis B virus, HBV testing, infectious disease prevention, health education, hepatitis B vaccination, disease prevention, university health, public health, Nigeria.