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Impact of Uterine Fibroid Support Services on Healthcare Utilization among Women Diagnosed with Fibroids in Nigeria

Abstract

Uterine fibroids are common benign tumours of the uterus that may affect women of reproductive age and can be associated with heavy menstrual bleeding, pelvic pain or pressure, anaemia, urinary symptoms, infertility, and other reproductive health concerns. Although fibroids are generally non-cancerous, symptoms may substantially affect women's physical, emotional, reproductive, and social wellbeing. Women diagnosed with uterine fibroids may require regular medical assessment, diagnostic monitoring, medication, surgical or non-surgical management, reproductive health counselling, and follow-up care. However, healthcare utilization among women with fibroids may be affected by limited knowledge, financial constraints, fear of surgery, cultural beliefs, stigma, geographical barriers, inadequate specialist services, and delays in seeking professional care. Uterine fibroid support services may provide patient education, counselling, treatment navigation, psychosocial support, specialist referral, reproductive health guidance, and follow-up assistance that can help women access appropriate care. Against this background, this study investigates the impact of uterine fibroid support services on healthcare utilization among women diagnosed with fibroids in Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Health Belief Model, and the Social Ecological Model. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and healthcare needs influence women's utilization of fibroid-related healthcare services. The Health Belief Model explains how women's perceptions of the seriousness of fibroids, perceived benefits of seeking appropriate care, perceived barriers, and cues to action may influence healthcare-seeking and utilization. The Social Ecological Model emphasizes the interaction between individual, interpersonal, healthcare-system, community, and broader societal factors in determining access to and utilization of healthcare services. Collectively, these theoretical perspectives provide a suitable framework for explaining how uterine fibroid support services may influence healthcare utilization among women diagnosed with fibroids in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women with a confirmed diagnosis of uterine fibroids attending selected hospitals, gynaecology clinics, specialist healthcare facilities, reproductive health centres, and fibroid support programmes across Nigeria. A multistage sampling technique will be used to select states, healthcare facilities, support organizations, and eligible women. Uterine fibroid support services will be assessed using indicators such as availability of patient education, counselling, treatment navigation, psychosocial support, reproductive health counselling, specialist referral, pain-management guidance, information on treatment options, financial or social support where available, follow-up services, accessibility, affordability, confidentiality, and continuity of care. Healthcare utilization will be assessed using indicators such as frequency of healthcare visits, gynaecological consultations, specialist consultations, diagnostic investigations, treatment attendance, medication-related consultations, surgical or non-surgical treatment utilization, reproductive health consultations, referral compliance, and follow-up attendance. Data will be collected using structured questionnaires, healthcare utilization records where appropriate, clinic attendance registers, referral records, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, exposure to fibroid support services, and patterns of healthcare utilization. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of uterine fibroid support services on healthcare utilization. Where a quasi-experimental design is adopted, healthcare utilization before and after implementation or expansion of support services may be compared to determine changes associated with the intervention, while relevant demographic, socioeconomic, clinical, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that accessible and comprehensive uterine fibroid support services have a significant positive impact on healthcare utilization among women diagnosed with fibroids in Nigeria. Women who receive structured education, counselling, treatment navigation, specialist referral, and follow-up support are expected to demonstrate greater utilization of appropriate healthcare services than women with limited access to support. Support services may improve women's understanding of fibroids, increase awareness of available treatment options, reduce misconceptions and fear regarding treatment, encourage timely consultation, and improve adherence to referrals and follow-up appointments. Effective support may also facilitate access to appropriate gynaecological, diagnostic, medical, surgical, and reproductive health services. However, financial barriers, geographical distance, limited specialist availability, inadequate healthcare infrastructure, cultural beliefs, fear of surgery, and delays in diagnosis may continue to restrict healthcare utilization. The study therefore expects accessible, affordable, coordinated, patient-centred, and culturally appropriate fibroid support services to contribute significantly to improved healthcare utilization among women diagnosed with uterine fibroids in Nigeria. The study is expected to contribute to the literature on uterine fibroid support services, healthcare utilization, fibroid management, women's reproductive health, gynaecological healthcare, patient education, treatment navigation, specialist healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, specialist gynaecology centres, healthcare providers, women's health organizations, fibroid support groups, development partners, and policymakers regarding strategies for improving healthcare utilization among women living with uterine fibroids. The study will also provide evidence-based recommendations for strengthening fibroid support programmes, improving patient education and counselling, expanding access to specialist services, strengthening referral and follow-up systems, improving access to diagnostic and treatment services, reducing financial and geographical barriers, and promoting coordinated patient-centred care for women diagnosed with uterine fibroids across Nigeria.

Keywords: Uterine fibroid support services, healthcare utilization, uterine fibroids, women, reproductive health, gynaecological healthcare, patient education, treatment navigation, specialist healthcare, healthcare-seeking, Nigeria, public health.