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Effect of Health Education on Knowledge of Palliative Care Services among Adults in Rural Nigeria

Abstract

Palliative care is an important component of comprehensive healthcare because it aims to improve the quality of life of people living with serious or life-limiting illnesses and to support their families through the prevention and management of pain, other physical symptoms, psychological distress, social challenges, and spiritual concerns. In Nigeria, access to and awareness of palliative care services may remain limited, particularly in rural communities where healthcare resources, specialist services, and referral pathways may be inadequate. Adults in rural communities may have limited knowledge of the purpose, availability, benefits, and eligibility for palliative care and may associate palliative care only with the final stages of dying. Such misconceptions may contribute to delayed referrals, underutilization of available services, and inadequate support for patients and families. Health education provides an opportunity to improve community understanding of palliative care and promote informed healthcare decisions. Against this background, this study investigates the effect of health education on knowledge of palliative care services among adults in rural Nigeria. The study will be anchored on the Health Belief Model, Health Literacy Theory, and Social Ecological Model. The Health Belief Model explains how adults' perceptions of serious illness, perceived severity, perceived benefits of palliative care, perceived barriers, and cues to action may influence their understanding and willingness to utilize palliative care services. Health Literacy Theory emphasizes the ability to obtain, understand, evaluate, and use health information appropriately, which is important for understanding palliative care and navigating available services. The Social Ecological Model emphasizes the influence of individual, family, community, healthcare-system, and broader social factors on awareness and access to palliative care. Collectively, these theoretical perspectives provide a suitable framework for explaining how health education may influence knowledge of palliative care services among adults in rural Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 18 years and above residing in selected rural communities in Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, rural communities, households, and eligible adults. Health education will be assessed using indicators such as exposure to palliative-care education sessions, frequency and duration of education, information on the meaning and purpose of palliative care, conditions that may benefit from palliative care, pain and symptom management, psychological and social support, family support, home-based palliative care, community-based services, referral pathways, available healthcare providers, misconceptions about palliative care, differences between palliative care and curative treatment, and appropriate timing for accessing palliative services. Knowledge of palliative care services will be assessed using indicators such as ability to define palliative care correctly, identify people who may benefit from palliative care, recognize pain and symptom-management services, identify psychological and social support services, recognize family and caregiver support, understand home-based and community-based palliative care, identify appropriate referral points, recognize that palliative care may be provided alongside disease-directed treatment where appropriate, and distinguish palliative care from end-of-life care alone. Data will be collected using structured questionnaires, standardized palliative-care knowledge assessment tools, scenario-based questions, community health-information assessment forms, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize participants' demographic and socioeconomic characteristics, previous exposure to palliative-care information, sources of health information, healthcare-seeking patterns, and baseline knowledge of palliative care services. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of health education on knowledge of palliative care services. Where a quasi-experimental design is adopted, knowledge scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that health education has a significant positive effect on knowledge of palliative care services among adults in rural Nigeria. Adults exposed to structured and culturally appropriate palliative-care education are expected to demonstrate greater knowledge of the purpose, benefits, services, eligibility, and referral pathways associated with palliative care than adults without comparable exposure. Education may improve understanding that palliative care focuses on improving quality of life and managing distressing symptoms and is not limited exclusively to the final days of life. It may also improve awareness of pain management, psychological and social support, family and caregiver support, and available home- or community-based services. Community discussions, pictorial materials, case scenarios, and engagement with healthcare workers may further improve adults' understanding of palliative care and reduce misconceptions. However, limited availability of palliative-care services, shortage of trained healthcare professionals, inadequate referral systems, financial barriers, transportation difficulties, cultural beliefs, low literacy, and misconceptions surrounding serious illness may reduce the effectiveness of education alone. The study therefore expects accessible, culturally appropriate, community-based, and sustained health education, supported by functional palliative-care and referral services, to contribute significantly to improved knowledge of palliative care services among adults in rural Nigeria. The study is expected to contribute to the literature on palliative care, health education, rural healthcare, health literacy, serious illness care, community health, healthcare access, quality of life, caregiver support, 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, primary healthcare centres, hospitals, palliative-care providers, healthcare professionals, community health workers, community and traditional leaders, development partners, public health practitioners, and policymakers regarding strategies for improving awareness and access to palliative care. The study will also provide evidence-based recommendations for expanding community-based palliative-care education, strengthening referral pathways, improving awareness of available palliative-care services, training healthcare workers in palliative-care communication, reducing misconceptions and stigma, and developing sustainable health-education programmes that improve knowledge of palliative care among adults across rural Nigeria.

Keywords: Health education, palliative care services, palliative care knowledge, adults, rural communities, health literacy, serious illness care, caregiver support, community health, Nigeria, public health.