HEALTH SEEKING BEHAVIOR TOWARDS HEALTH PROMOTION AMONG FAMILIES WITH ELDERLY IN ISIALA MBANO LGA IMO STATE

ABSTRACT

The purpose of this study was to examine health seeking behavior towards health promotion among families with elderly in Isiala Mbano Local Government Area (LGA), Imo State. Aging is a global demographic phenomenon associated with increasing burdens of non-communicable diseases and declining functional capacity, trends that are now well documented in low- and middle-income countries including Nigeria (Folorunsho, 2025; Oche et al., 2024; World Health Organization [WHO], 2024). In Nigeria, an estimated 6% of the population were aged 60 years and above in 2024, a figure projected to exceed 30 million persons by 2050, yet formal healthcare services remain largely inaccessible, unaffordable, or underutilized by this group (Folorunsho, 2025; Ibrahim et al., 2023). To achieve the purpose of this study, an ex-post facto research design was adopted to assess 399 respondents drawn from three clans of Isiala Mbano LGA through a stratified sampling technique. A closed-ended questionnaire was used to collect data; 400 copies were distributed and 399 were retrieved and found usable. Data were analyzed using descriptive statistics (frequency counts, percentages, means, and standard deviations) and inferential statistics (one-way ANOVA, Scheffe post-hoc test, and independent samples t-test), with a 0.05 level of significance applied throughout. The findings reveal that age has a statistically significant effect on health care seeking behavior among elderly persons in Isiala Mbano LGA, with the poorest health-seeking behavior observed among those aged 80 years and above compared to those in the 60-64 and 70-74 age brackets. This pattern is consistent with recent literature from comparable Nigerian communities (Adewole, Aremu, & Ibrahim, 2023; Oche et al., 2024). It was concluded that advancing age is a significant factor in declining healthcare-seeking behavior among the aged in Isiala Mbano LGA. Recommendations include that government authorities should mount sustained public enlightenment campaigns for the elderly, promote cost reduction in healthcare services, and integrate disease management programs into local health delivery systems.

Keywords: health seeking behavior, health promotion, elderly, aging, Isiala Mbano, Imo State, Nigeria.

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Aging is a lifelong, universal biological process that manifests differently across individuals and is shaped by a complex interplay of genetic, environmental, social, and behavioral factors. The term "elderly" is most commonly applied to persons aged 60 years and above in developing nations and 65 years and above in high-income settings (WHO, 2024; Oche et al., 2024). At its core, aging represents the progressive accumulation of changes in an organism over time, alterations that eventually elevate the probability of disease and death as the individual grows older (Huang & Oteng, 2023; PMC Response, 2023).

Population aging has emerged as one of the most consequential demographic shifts of the twenty-first century. According to the United Nations World Population Prospects (2022), the proportion of the global population aged 60 years and above surpassed 10% in the early part of this century. Globally, life expectancy at birth reached 73.3 years in 2024, an increase of 8.4 years since 1995, and the number of people aged 60 and older worldwide is projected to grow from 1.1 billion in 2023 to 1.4 billion by 2030 (WHO, 2024). Remarkably, it is estimated that by the middle of this century approximately 80% of the world's elderly population will reside in low- and middle-income countries (LMICs), making geriatric health a pressing concern for the Global South (PMC Response, 2023; WHO, 2024).

Nigeria is no exception to this global trend. The country's aging population has grown from 4.61% in 2020 to an estimated 4.78% in 2022, with a significant proportion suffering from long-term, non-communicable diseases (NCDs) of insidious onset, including cardiovascular diseases, cerebrovascular accidents, cancers, diabetes mellitus, and musculoskeletal disorders (Oche et al., 2024). The proportion of Nigerians aged 60 and above stood at approximately 6% in 2024 and is forecast to exceed 30 million persons by 2050, representing a significant policy burden on the country's health systems (Folorunsho, 2025; Adewole et al., 2023). Notwithstanding these demographic realities, Nigeria's primary healthcare infrastructure was historically designed around maternal, child health, and infectious disease management, leaving the needs of older adults systematically underserved (Barriers and Facilitators, 2024; Factors Influencing Primary Health Care, 2025).

Healthcare-seeking behavior among the elderly in Nigeria is characteristically poor, particularly in rural communities. Recent studies confirm that large proportions of elderly Nigerians resort to self-medication, patronage of patent medicine vendors, use of local herbal remedies, and consultation of spiritual healers when ill, rather than utilizing formal healthcare facilities (Adewole et al., 2023; Ibrahim et al., 2023; Gender and Health Seeking Behavior, 2023). In Ido-Ekiti, for instance, a cross-sectional study of 420 elderly respondents found that while 63.3% had experienced at least one episode of illness in the preceding year, only 35.3% consulted a qualified medical doctor, whereas 57.9% admitted utilizing self-medication, herbal treatments, or spiritual consultations as their primary response to illness (Adewole et al., 2023). A comparable study in a rural community of Sokoto State corroborated these findings, reporting that less than half (47.8%) of respondents engaged in appropriate health-seeking practices by visiting health facilities during illness episodes (Oche et al., 2024).

Multiple determinants have been identified as influencing health-seeking behavior among elderly Nigerians. Economic constraints rank as the most pervasive barrier, with over 70% of health expenditure in Nigeria funded through out-of-pocket payments, rendering formal healthcare unaffordable for many elderly persons who subsist on limited or no formal income (Folorunsho, 2025; Sociocultural Barriers Review, 2025). Geographic disparities between urban and rural areas compound this challenge, as infrastructure limitations and healthcare workforce shortages disproportionately disadvantage elderly persons in rural settings (Oche et al., 2024; Barriers and Facilitators, 2024). Sociocultural factors, including deeply rooted beliefs that age-related ill health is a natural phenomenon beyond medical intervention, further reinforce avoidance of formal care (Sociocultural Barriers Review, 2025; Adewole et al., 2023).

Gender also plays a documented role in shaping health-seeking patterns. Older women in Nigeria frequently face restricted autonomous decision-making due to prevailing patriarchal norms, economic hardship, and caregiving responsibilities, while older men are more inclined to delay care-seeking behaviors until conditions become severe (Folorunsho & Suleman, 2025; Obilor, 2023). Educational attainment is similarly associated with health-seeking behavior; individuals with higher levels of formal education tend to demonstrate superior health literacy, greater awareness of available services, and more proactive engagement with the healthcare system (Adewole et al., 2023; Ayub, Iliya, & Abubakar, 2022; Oche et al., 2024).

At the global policy level, the World Health Organization's Decade of Healthy Ageing (2021-2030) has called on member states to align health systems with the functional needs of older people, reduce age-related health inequities, and foster integrated, person-centered care models (WHO, 2024; PMC Response, 2023). Nigeria, as a signatory to the relevant WHO frameworks, is under increasing pressure to translate these commitments into concrete health policy actions, including expanding community-based geriatric care, subsidizing healthcare costs for elderly persons, and training a cadre of healthcare workers equipped to manage the chronic disease burden of an aging population (Barriers and Facilitators, 2024; Factors Influencing Primary Health Care, 2025).

Isiala Mbano LGA of Imo State, located in southeastern Nigeria, reflects the broader Nigerian context of rural elderly populations confronting multiple barriers to health promotion and healthcare utilization. The LGA encompasses diverse clans whose elderly members face the compound disadvantages of rural geography, economic vulnerability, low health literacy, and culturally influenced health-seeking patterns. Despite the growing policy relevance of elderly health in Nigeria, empirical studies that systematically assess health-seeking behavior in this specific geographic context remain sparse. This study therefore contributes to the evidence base by examining the determinants of health-seeking behavior among families with elderly persons in Isiala Mbano LGA, with particular attention to the roles of age, gender, and educational level in shaping these behaviors.

1.2 STATEMENT OF THE PROBLEM

Healthcare services are a critical component of quality living, yet for the elderly population in rural Nigeria, accessing and utilizing these services remains a profound and persistent challenge. Nigeria's healthcare system was predominantly built around the needs of younger demographic groups, particularly mothers and children, and has been slow to adapt to the growing geriatric population (Barriers and Facilitators, 2024; Factors Influencing Primary Health Care, 2025). As a consequence, the health needs of the elderly are often unmet, underrecognized, and inadequately addressed at both the policy and facility levels.

Healthcare-seeking behavior is poor among the aged in sub-Saharan Africa, including Nigeria, and this inadequacy escalates the burden of noncommunicable diseases while simultaneously increasing the cost of care (Adewole et al., 2023; Oche et al., 2024). Elderly persons in communities such as Isiala Mbano LGA commonly suffer from age-associated chronic illnesses, including hypertension, cardiac disease, diabetes mellitus, musculoskeletal disorders, kidney infections, cancer, and tuberculosis, conditions that demand consistent and long-term medical management (Folorunsho, 2025; Oche et al., 2024). However, due to the absence of awareness, financial barriers, infrastructure deficits, and cultural beliefs, many elderly persons in this LGA and similar rural communities resort to patent medicine stores, traditional healers, herbal remedies, and self-medication rather than seeking care from qualified health professionals (Adewole et al., 2023; Sociocultural Barriers Review, 2025).

The poor implementation of the National Health Policy as it relates to elderly care, the inadequacy of healthcare facilities, shortages of trained personnel, and the high cost of treatment further compound the problem. Over 70% of health expenditure in Nigeria is borne out-of-pocket by patients and their families, a financial model that is particularly punishing for elderly persons living without pensions or formal income support (Folorunsho, 2025). Additionally, gender dynamics and low levels of formal education among elderly persons in rural areas restrict health literacy and the ability to make informed decisions about health-seeking (Ayub et al., 2022; Obilor, 2023).

Despite the significance of these challenges, there is a notable paucity of empirical research examining health-seeking behavior specifically among families with elderly persons in Isiala Mbano LGA, Imo State. This research gap makes it difficult for policymakers and health managers to design targeted interventions that are contextually appropriate for this population. The present study therefore seeks to systematically assess health-seeking behavior toward health promotion among families with elderly persons in Isiala Mbano LGA of Imo State, contributing evidence that can guide health policy and programming for this underserved group.

1.3 RESEARCH OBJECTIVES

The general objective of the study is to assess health seeking behavior towards health promotion among families with elderly persons in Isiala Mbano LGA of Imo State, Nigeria. The specific objectives are:

1. To determine the effect of aging on healthcare seeking behavior among families with elderly persons in Isiala Mbano LGA of Imo State.

2. To examine the healthcare-seeking practices of elderly persons in Isiala Mbano LGA of Imo State.

3. To determine whether gender influences health seeking behavior towards health promotion among families with elderly persons in Isiala Mbano LGA of Imo State.

4. To assess the influence of educational level on health seeking behavior among families with elderly persons in Isiala Mbano LGA of Imo State.

1.4 RESEARCH QUESTIONS

The following research questions were formulated to guide the study:

1. What is the effect of aging on healthcare seeking behavior among families with elderly persons in Isiala Mbano LGA of Imo State?

2. What are the healthcare-seeking practices of elderly persons towards health promotion in Isiala Mbano LGA of Imo State?

3. Does gender have any significant difference on health seeking behavior towards health promotion among families with elderly persons in Isiala Mbano LGA of Imo State?

4. Does educational level significantly influence health seeking behavior among families with elderly persons in Isiala Mbano LGA of Imo State?

1.5 RESEARCH HYPOTHESES

The following null hypotheses were formulated to guide the empirical investigation:

1. HO₁: Aging has no significant effect on healthcare seeking behavior among families with elderly persons in Isiala Mbano LGA of Imo State.

2. HO₂: Gender has no significant difference on health seeking behavior towards health promotion among families with elderly persons in Isiala Mbano LGA of Imo State.

3. HO₃: Educational level has no significant influence on health seeking behavior among families with elderly persons in Isiala Mbano LGA of Imo State.

1.6 SIGNIFICANCE OF THE STUDY

This study holds significant implications for multiple stakeholders in the health sector, local governance, and the wider academic community. At the community level, the findings will deepen the understanding of elderly persons and their families regarding the importance of preventive and promotive healthcare, empowering them to make informed decisions about health-seeking and disease prevention. As the popular adage affirms, prevention is better than cure; this study reinforces that principle by generating evidence to support investment in health-promoting behaviors among aging populations.

For health policymakers and government agencies, the study provides empirical evidence from a rural southeastern Nigerian context, which can inform the design of targeted elderly health programs. Given that Nigeria's older adult population is projected to exceed 30 million by 2050, and given the documented gap between health need and service utilization (Folorunsho, 2025; Oche et al., 2024), evidence-based programs that address economic, cultural, and infrastructural barriers are urgently needed. This research contributes to that evidence base.

Healthcare administrators and primary health center managers in Isiala Mbano LGA and comparable rural settings can use the findings to redesign service delivery models that are more responsive to the needs of elderly users, including outreach programs, mobile health clinics, and community-based health education. The study also contributes to academic literature on geriatric health in Nigeria, a field that remains relatively underdeveloped relative to the growing demographic burden. Finally, the results will enable various villages within Isiala Mbano LGA to assess their relative levels of health-promoting engagement and identify areas requiring improvement.

1.7 SCOPE AND LIMITATIONS OF THE STUDY

The study focused on assessing health seeking behavior towards health promotion among families with elderly persons in Isiala Mbano LGA of Imo State, Nigeria. The respondents comprised male and female elderly persons aged 60 years and above, as well as family members of elderly persons, residing across three selected clans within the LGA. The study was limited to health-seeking behavior in relation to health promotion, and did not extend to clinical assessment of health conditions or evaluation of specific treatment outcomes.

The limitations of the study include time constraints, which restricted the scope of geographic coverage within the LGA; financial constraints, which affected the scale of data collection; and restricted access to comprehensive and current documentary materials on the study area. Respondents' self-reported data may also be subject to recall and social desirability biases. These limitations notwithstanding, efforts were made to ensure rigor in sampling, instrument design, and data analysis.

1.8 OPERATIONAL DEFINITION OF TERMS

Health-Seeking Behavior: Within the context of this study, health-seeking behavior refers to the sequence of actions and decisions that individuals and their families undertake in response to perceived ill-health, including the choice of healthcare provider, timing of care-seeking, level of treatment compliance, and the reasons informing those choices (Adewole et al., 2023; Oche et al., 2024). It encompasses both formal (hospital, clinic, primary health center) and informal (self-medication, patent medicine vendors, traditional healers, spiritualists) pathways of care.

Health Promotion: As applied in this study, health promotion refers to any planned combination of educational, policy, environmental, organizational, or community-level interventions designed to support behaviors, conditions, and environments conducive to the health of individuals, groups, and communities (WHO, 2024). Health promotion encompasses a broad spectrum of activities ranging from public health policy formulation to individual behavioral change education, addressing social determinants of health and health literacy as key enabling factors.

Elderly: In the context of this research, elderly refers to any male or female person aged 60 years and above, in line with the age threshold adopted by the World Health Organization for low- and middle-income countries including Nigeria (Oche et al., 2024; Folorunsho, 2025).

Health Promotion Behavior: This refers to any purposive action undertaken by an individual to enhance or maintain their level of well-being, self-actualization, and personal fulfillment, as distinguished from health-protecting behaviors aimed solely at disease prevention (Xie et al., 2022).

Families with Elderly: For the purposes of this study, this term denotes household units in which at least one member is aged 60 years and above, and which therefore bear responsibility for making decisions about the care and health-seeking behavior of that elderly member.

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