KNOWLEDGE AND UTILIZATION OF TELEMEDICINE SERVICES AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC IN LAGOS UNIVERSITY TEACHING HOSPITAL (LUTH), LAGOS STATE

ABSTRACT

Background: Telemedicine, defined as the delivery of healthcare services using digital communication technologies across distance, has emerged as a transformative strategy to improve access to antenatal care, especially in resource-constrained environments. Lagos University Teaching Hospital (LUTH), located in Idi-Araba, Lagos State, serves as a primary referral and specialist centre for thousands of pregnant women annually. With the rapid expansion of mobile phone penetration and internet connectivity in Nigeria, telemedicine presents enormous potential to complement conventional antenatal care services.

Objective: This study aims to assess the level of knowledge and utilization of telemedicine services among pregnant women attending antenatal clinic at LUTH, Lagos State, and to identify barriers and facilitators to telemedicine adoption.

Methods: A descriptive cross-sectional study design was employed. Data were collected from pregnant women attending antenatal clinic at LUTH using a validated, pretested, structured questionnaire. Systematic random sampling was used to select 350 participants. Data were analysed using SPSS version 25.0.

Expected Findings: It is anticipated that while a large proportion of participants will demonstrate moderate awareness of telemedicine, actual utilization rates will be low, constrained by digital literacy gaps, poor internet connectivity, affordability concerns, and preference for face-to-face consultation.

Conclusion: Improving telemedicine knowledge and utilization among pregnant women at LUTH will require targeted health education, enhanced digital infrastructure, and policy-driven integration of telemedicine platforms into routine antenatal care protocols.

Keywords: Telemedicine, antenatal care, pregnant women, LUTH, Lagos, digital health, maternal healthcare.

CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND TO THE STUDY

Globally, the integration of digital health technologies into maternal healthcare has redefined the boundaries of antenatal care delivery. Telemedicine encompassing telehealth consultations, Health applications, remote monitoring, and video-based patient education has been shown to improve antenatal care outcomes by extending the reach of healthcare services beyond physical facilities and into the homes and communities of pregnant women (Khoong et al., 2021). In low- and middle-income countries (LMICs), where overcrowded antenatal clinics, transportation barriers, and healthcare worker shortages converge to limit access, telemedicine holds particular promise.

Nigeria's rapid increase in mobile phone usage with over 220 million active mobile subscribers as of 2023 and growing internet penetration rates present a favourable infrastructure for telemedicine expansion (Nigerian Communications Commission [NCC], 2023). Yet, despite this potential, the integration of telemedicine into mainstream maternal healthcare in Nigeria remains nascent, fragmented, and poorly evaluated. Lagos, as Nigeria's most populous state and commercial nerve centre, presents a unique context for investigating telemedicine adoption among pregnant women given its combination of relatively high digital literacy and significant socioeconomic diversity.

Lagos University Teaching Hospital (LUTH) is one of Nigeria's premier federal tertiary health institutions, established in 1962. Its antenatal clinic accommodates thousands of registered pregnant women each year, making it one of the highest-volume antenatal units in Nigeria. The hospital has made incremental efforts to incorporate digital health tools into its service delivery, yet comprehensive data on the knowledge and utilization of telemedicine among its antenatal clients remain scarce (Ekwueme et al., 2022). Understanding the current landscape of telemedicine awareness and use among pregnant women at LUTH is therefore an essential step toward evidence-based policy and programme design.

Research from comparable LMICs demonstrates that telemedicine can significantly reduce missed antenatal visits, improve health literacy, facilitate timely identification of obstetric risk factors, and enhance communication between patients and providers (Tomlinson et al., 2021; Odendaal et al., 2022). However, the evidence base from Nigeria, and specifically from Lagos, remains insufficient to drive institutional or national-level policy decisions on telemedicine integration in antenatal care. This study is positioned to address that gap, generating institution-specific data that can serve as a foundation for broader telemedicine policy within LUTH and across Nigeria's tertiary health sector.

The concept of telemedicine in healthcare is not new. Its roots can be traced to the 1960s, when NASA pioneered remote patient monitoring for astronauts (WHO, 2010). However, it was the convergence of mobile telecommunications, broadband internet, and affordable digital devices that transformed telemedicine from a niche application into a globally viable healthcare delivery model. The COVID-19 pandemic served as an unprecedented catalyst for telemedicine adoption worldwide, as lockdowns and infection control protocols necessitated remote healthcare delivery on a mass scale (Khoong et al., 2021).

In the context of maternal healthcare, telemedicine encompasses a spectrum of applications including synchronous video consultations between pregnant women and midwives or obstetricians, asynchronous messaging platforms for symptom reporting, mHealth apps for dietary and medication reminders, telemonitoring devices for blood pressure and fetal heart rate, and online antenatal education platforms (Odendaal et al., 2022). These innovations have the potential to democratise access to quality antenatal care, particularly for pregnant women who face structural barriers to in-person attendance.

Nigeria's maternal health crisis is well documented. The country's high maternal mortality ratio, estimated at 512 per 100,000 live births, is driven in large part by inadequate antenatal care coverage, poor quality of intrapartum services, and delayed access to emergency obstetric care (WHO, 2023). Lagos State, while better resourced than many other Nigerian states, faces its own challenges, including extreme urban congestion, high transportation costs, long waiting times at antenatal clinics, and a significant burden of pregnancy complications related to hypertension, gestational diabetes, and anaemia (Tomlinson et al., 2021).

Several telemedicine platforms have been piloted in Nigeria, including the Living Health platform, MDaaS Global, Helium Health, and the Federal Ministry of Health's integrated eHealth strategy. However, uptake among pregnant women has been inconsistent, and knowledge gaps about available services remain substantial (Ekwueme et al., 2022). LUTH's antenatal unit, as a premier referral facility, offers a strategic study site for examining telemedicine knowledge and utilization among a diverse and high-volume population of pregnant women.

1.2 STATEMENT OF THE PROBLEM

Despite the proliferation of digital health platforms in Nigeria and the documented potential of telemedicine to improve antenatal care coverage and quality, utilization of telemedicine services among pregnant women remains poorly characterised at Nigerian teaching hospitals. At LUTH, where antenatal clinic attendance can be challenging due to long waiting times, traffic congestion, and the demands of urban working life, telemedicine could serve as a practical supplement to conventional care. Yet, there is a dearth of empirical studies evaluating whether pregnant women attending LUTH are aware of telemedicine, whether they use it, and what factors promote or impede its uptake.

Without such data, it is impossible for hospital management, programme planners, and policymakers to make informed decisions about investing in telemedicine infrastructure, training healthcare providers in digital consultation skills, or designing patient education campaigns to improve telemedicine literacy. The consequences of this gap are particularly significant in light of Nigeria's maternal mortality burden and the critical role of consistent antenatal care attendance in preventing maternal death. This study is therefore designed to systematically assess telemedicine knowledge and utilization among pregnant women at LUTH, providing the evidence base necessary for targeted telemedicine integration strategies.

1.3 OBJECTIVES OF THE STUDY

The general objective is to assess the knowledge and utilization of telemedicine services among pregnant women attending antenatal clinic at LUTH, Lagos State.

Specific objectives are to:

1. Determine the level of knowledge of telemedicine services among pregnant women attending antenatal clinic at LUTH.
2. Assess the pattern of utilization of telemedicine services among the study participants.
3. Identify the barriers to telemedicine utilization among pregnant women at LUTH.
4. Examine the facilitators of telemedicine adoption among the study population.
5. Determine the relationship between sociodemographic factors and knowledge and utilization of telemedicine services among respondents.

1.4 RESEARCH QUESTIONS

1. What is the level of knowledge of telemedicine services among pregnant women attending antenatal clinic at LUTH?
2. What is the pattern of utilization of telemedicine services among the study participants?
3. What are the barriers to telemedicine utilization among pregnant women at LUTH?
4. What factors facilitate telemedicine adoption among pregnant women attending LUTH?
5. Is there a significant relationship between sociodemographic characteristics and knowledge and utilization of telemedicine among respondents?

1.5 RESEARCH HYPOTHESES

H01: There is no significant relationship between the level of education of pregnant women and their knowledge of telemedicine services at LUTH.

H02: There is no significant association between income level and telemedicine utilization among pregnant women attending antenatal clinic at LUTH.

H03: There is no significant relationship between parity and the likelihood of telemedicine utilization among pregnant women at LUTH.

1.6 SIGNIFICANCE OF THE STUDY

The significance of this study extends across clinical, administrative, educational, and policy dimensions. Clinically, the findings will enable midwives, nurses, and obstetricians at LUTH to better understand the digital health readiness of their antenatal patients, facilitating the development of patient-centred telemedicine integration strategies.

Administratively, the study will provide LUTH's hospital management with data needed to make evidence-based investments in telemedicine infrastructure, including secure consultation platforms, patient education resources, and staff training programmes. At the state and national policy levels, the findings contribute to Lagos State's Digital Health Strategy and the Federal Ministry of Health's eHealth agenda by providing granular institutional data on telemedicine adoption among a key healthcare-seeking population.

For the midwifery and nursing professions, this study reinforces the importance of digital health competency as a core component of contemporary maternal healthcare delivery. The findings can also inform the revision of midwifery curricula to incorporate telemedicine training, ensuring that future midwives are equipped to support pregnant women in navigating digital health tools.

1.7 SCOPE OF THE STUDY

This study is confined to the antenatal clinic of Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos State. The target population consists of pregnant women in their second and third trimesters who are registered and attending the antenatal clinic during the study period. The study focuses on knowledge and utilization of telemedicine services, including mHealth applications, teleconsultation platforms, and remote monitoring services related to antenatal care. It does not extend to postnatal telemedicine use or to other units within LUTH. Data collection is limited to the period of the academic session during which the study is conducted.

1.8 LIMITATIONS OF THE STUDY

Several limitations are anticipated in this study. First, recall bias may affect responses related to past telemedicine use, as participants may inaccurately recall the frequency or nature of prior digital health interactions. Second, social desirability bias may lead participants to overstate their telemedicine knowledge, particularly given the academic setting of the study. Third, as a single-institution study at a high-profile tertiary hospital, findings may not be fully generalisable to antenatal clients in primary or secondary healthcare facilities or in rural settings. Fourth, rapidly changing telemedicine landscapes including the emergence of new platforms and services may affect the contemporaneity of findings over time. These limitations will be mitigated through anonymous data collection, careful questionnaire design, and triangulation where possible.

1.9 DEFINITION OF TERMS

Telemedicine: The delivery of healthcare services, where patients and providers are separated by distance, using information and communication technologies (ICT) for the exchange of valid information for diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers (WHO, 2010).

Antenatal Care (ANC): A programme of care and surveillance for the pregnant woman and her developing baby, provided by trained health professionals from conception to the onset of labour, to optimise maternal and fetal outcomes (WHO, 2016).

mHealth (Mobile Health): The use of mobile devices, including mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices, to support medical and public health practices (WHO, 2011).

Knowledge: The degree of understanding, awareness, and accurate information a pregnant woman possesses regarding telemedicine services, their availability, and their application in antenatal care (Ekwueme et al., 2022).

Utilization: The actual use of telemedicine services by pregnant women during the antenatal period, including the frequency, type, and perceived benefit of such services (Odendaal et al., 2022).

Digital Health Literacy: The ability of individuals to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem (Khoong et al., 2021).

Teleconsultation: A real-time or asynchronous communication between a patient and a healthcare provider using digital platforms such as video calls, messaging apps, or dedicated healthcare portals (Tomlinson et al., 2021).

Barrier: Any factor financial, cultural, technological, educational, or infrastructural that inhibits the awareness or use of telemedicine services among pregnant women (Odendaal et al., 2022).

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