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Impact of Discharge Counselling on Post-Hospitalization Care Practices among Adult Patients in Nigeria

Abstract

Post-hospitalization care is an important component of continuity of healthcare and may influence patients' recovery, prevention of complications, medication adherence, follow-up attendance, and appropriate healthcare-seeking after discharge. Adult patients in Nigeria may experience difficulties after leaving the hospital because of inadequate understanding of discharge instructions, medication schedules, dietary recommendations, wound care, activity restrictions, warning signs, follow-up appointments, and appropriate use of healthcare services. Inadequate discharge preparation may contribute to medication errors, avoidable complications, readmission, delayed recovery, and inappropriate self-management. Discharge counselling provides an opportunity to ensure that patients understand their post-hospitalization care requirements and are able to continue appropriate care at home. Against this background, this study investigates the impact of discharge counselling on post-hospitalization care practices among adult patients in Nigeria. The study will be anchored on the Health Belief Model, Health Literacy Framework, and Social Cognitive Theory. The Health Belief Model explains how patients' perceptions of the seriousness of their health condition, perceived benefits of following discharge instructions, perceived barriers, self-efficacy, and cues to action may influence post-hospitalization care practices. The Health Literacy Framework emphasizes patients' ability to access, understand, evaluate, and apply health information provided during discharge. Social Cognitive Theory emphasizes observational learning, self-efficacy, reinforcement, social support, and environmental influences in shaping patients' ability to maintain appropriate care practices after hospitalization. Collectively, these theoretical perspectives provide a suitable framework for explaining how discharge counselling may influence post-hospitalization care practices among adult patients in 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 discharged from selected public and private hospitals across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, hospitals, departments or wards, and eligible patients. Discharge counselling will be assessed using indicators such as receipt of counselling before discharge, duration and content of counselling, explanation of diagnosis and treatment, medication instructions, dosage and timing, dietary recommendations, wound and personal care, activity restrictions, warning signs requiring urgent attention, follow-up appointments, referral instructions, use of prescribed medicines, lifestyle recommendations, available support services, and opportunities for patients or caregivers to ask questions. Post-hospitalization care practices will be assessed using indicators such as medication adherence, adherence to dietary and activity recommendations, wound-care practices where applicable, recognition and response to warning signs, attendance at follow-up appointments, appropriate healthcare-seeking, compliance with referral instructions, use of prescribed treatments, self-monitoring where required, and appropriate communication with healthcare providers when problems occur after discharge. Data will be collected using structured questionnaires, standardized discharge-counselling and post-hospitalization care assessment tools, hospital discharge records, follow-up records where available, and pre-test and post-test or follow-up assessments where a quasi-experimental design is adopted. Descriptive statistics will be used to summarize patients' demographic and socioeconomic characteristics, hospitalization experiences, discharge information received, sources of health information, and post-hospitalization care practices. 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 impact of discharge counselling on post-hospitalization care practices. Where a quasi-experimental design is adopted, post-hospitalization care practice scores before and after the counselling 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 discharge counselling has a significant positive impact on post-hospitalization care practices among adult patients in Nigeria. Patients who receive clear, structured, patient-centred, and practical discharge counselling are expected to demonstrate better adherence to recommended post-hospitalization care practices than patients who receive limited or no comparable counselling. Counselling may improve patients' understanding of medication use, dietary and activity recommendations, wound care, warning signs, follow-up appointments, referral procedures, and appropriate healthcare-seeking. Practical demonstrations and teach-back approaches may further improve patients' ability to correctly perform required home-care activities and identify situations requiring professional medical attention. However, low health literacy, language barriers, financial constraints, limited caregiver support, poor access to medicines, transportation difficulties, inadequate follow-up systems, and insufficient time for discharge counselling may reduce its effectiveness. The study therefore expects comprehensive, individualized, culturally appropriate, and sustained discharge counselling, supported by effective follow-up and referral systems, to contribute significantly to improved post-hospitalization care practices among adult patients in Nigeria. The study is expected to contribute to the literature on discharge counselling, post-hospitalization care, patient education, continuity of care, health literacy, medication adherence, healthcare utilization, patient safety, hospital care, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, public and private hospitals, hospital administrators, physicians, nurses, pharmacists, allied health professionals, patient-relations departments, public health practitioners, development partners, and policymakers regarding strategies for improving continuity of care after hospitalization. The study will also provide evidence-based recommendations for strengthening discharge counselling protocols, incorporating teach-back methods into discharge processes, improving patient and caregiver education, strengthening post-discharge follow-up systems, improving communication between hospitals and community healthcare providers, and developing sustainable patient-centred interventions that support safe and effective post-hospitalization care across Nigeria.

Keywords: Discharge counselling, post-hospitalization care practices, adult patients, patient education, continuity of care, medication adherence, health literacy, discharge planning, patient safety, healthcare utilization, Nigeria, public health.