Rural Nigerian Women Say Yes to Telehealth When Benefits Feel Real, Study Finds

Nigeria carries one of the heaviest maternal health burdens on the planet, accounting for close to one-third of all maternal deaths worldwide, and the women who die most often are those living far from the skilled care that could save them. In rural communities, understaffed primary health centres, long distances to referral hospitals, and chronic shortages of trained providers combine into a lethal geography of exclusion. Telehealth, the delivery of health services through phones, computers, and other digital channels, has long been promoted as a way to leapfrog these barriers. But a technology can only save lives if the people it is meant to serve are actually willing to use it, and until now, evidence on that demand-side readiness among rural Nigerian women has been strikingly thin.

A new study published in BMC Health Services Research offers one of the clearest pictures yet of what drives rural women of reproductive age to embrace or reject digital maternal care. Researchers Deborah Anjolajesu Elegbeleye and Motunrayo Florence Olanrewaju, both of the Department of Public Health at Babcock University in Ogun State, surveyed 336 women aged 15 to 49 who were attending nine rural primary health centres spread across three Local Government Areas in the Ibadan zone of Oyo State: Ido, Oluyole, and Ona Ara. Using multistage probability sampling, a technique that randomly selects clusters at successive levels to produce a representative sample, the team captured a snapshot of women who rely on exactly the kind of under-resourced facilities that telehealth is supposed to strengthen.

The instrument at the heart of the study was the Rural Telehealth Adoption Assessment Questionnaire, or R-TAAQ, a validated bilingual tool designed specifically for rural populations. Its architecture draws on three of the most influential frameworks in health behaviour and technology research: the Technology Acceptance Model, which emphasises perceived usefulness and ease of use; the Health Belief Model, which focuses on how people weigh susceptibility, severity, and benefit; and the Unified Theory of Acceptance and Use of Technology, which incorporates social influence and facilitating conditions. By grounding the questionnaire in these models, the researchers could measure not just whether women knew about telehealth, but whether they believed it would help them and whether they intended to use it.

The headline finding is genuinely encouraging. Nearly two-thirds of the women, 62.8 percent, demonstrated high knowledge of telehealth, scoring an average of 5.80 out of a possible 8 points on the knowledge scale. Even more striking, 82.4 percent held positive perceptions of its benefits, with a mean benefit score of 25.6 out of 30. And willingness to adopt was high across the board: 83.9 percent of respondents said they were willing to embrace telehealth for their maternal and reproductive health needs, averaging 11.1 out of 15 on the willingness scale. The response rate of 93.6 percent suggests these figures reflect genuine engagement rather than the skewed views of a small, self-selected minority.

But the statistical core of the study lies in what predicted that willingness, and here the results take an unexpected turn. Using chi-square tests, Pearson correlations, and binary logistic regression, the researchers tested whether knowledge, perceived benefits, facilitating conditions such as infrastructure and support, and a full range of socio-demographic characteristics shaped adoption intention. Perceived benefits emerged as the only variable significantly associated with willingness to adopt, with a chi-square statistic of 46.774 and a p-value below 0.001. Knowledge of telehealth, by contrast, showed no significant association at all, with a p-value of 0.428, and facilitating conditions produced a correlation coefficient of just 0.037, statistically indistinguishable from zero.

The logistic regression sharpened the picture further. Women who perceived strong benefits from telehealth were more than eleven times as likely to be willing to adopt it, with an adjusted odds ratio of 11.274 and a 95 percent confidence interval running from 5.427 to 23.422. The model explained a meaningful share of the outcome, with a Nagelkerke R-squared of 0.254, and correctly classified 84.5 percent of cases. In plain terms, believing that telehealth would genuinely improve one’s care was the dominant force behind the decision to embrace it. Neither age, education, income, nor any other demographic factor reached significance, with the single exception of parity: women with three or four children were dramatically less willing to adopt, with an adjusted odds ratio of 0.073 and a p-value of 0.027.

That parity finding deserves careful attention. Women who have already borne several children may feel they have managed pregnancy and childbirth successfully without digital tools, or they may face time constraints and caregiving burdens that make new technologies feel like one demand too many. Whatever the mechanism, the result signals that telehealth programmes cannot treat rural women as a uniform bloc. Mothers of larger families may need tailored outreach, different service designs, or different channels of communication altogether if they are not to be left behind by a digital transition that benefits their neighbours.

The deeper lesson, however, is the one about benefits versus knowledge. For years, digital health advocates in low- and middle-income countries have assumed that the path to adoption runs through education: teach people what telehealth is, and uptake will follow. This study suggests that assumption is backwards, at least for this population. Women in these rural Ibadan communities already knew a great deal about telehealth, and that knowledge did not move the needle on their intentions. What moved the needle, overwhelmingly, was whether they believed the technology would deliver real, tangible improvements to their maternal care. The practical implication is that benefit-focused communication, messages that demonstrate concretely how a virtual consultation saves a dangerous journey or connects a pregnant woman to a skilled provider, will do far more work than awareness campaigns alone.

The authors are careful to note that willingness is not the same as sustained use. Intention is a necessary starting point, but structural barriers, unreliable electricity, patchy mobile networks, the cost of data, and the availability of devices, can still derail adoption after the initial enthusiasm. The study’s finding that facilitating conditions did not predict willingness does not mean infrastructure is irrelevant; it means that infrastructure alone will not create demand. The researchers conclude that telehealth promotion in rural primary health care settings should prioritise benefit-focused messaging while simultaneously addressing those structural obstacles to enable sustained engagement, a two-track strategy that treats perception and provision as equally essential.

For a country where rural women bear a disproportionate share of nearly one-third of the world’s maternal deaths, the stakes of getting this right could hardly be higher. What this study offers is a demand-side evidence base that has been missing from the conversation: rural Nigerian women are not waiting to be convinced that telehealth exists, and they are not blocked by ignorance or indifference. They are, by and large, ready. What they need is to be shown, convincingly and repeatedly, that the technology will make a real difference to their health and the health of their babies, and to be given the infrastructure that lets that promise hold. The digital bridge to safer motherhood, it turns out, is built first in the mind.

Subject of Research: Telehealth adoption readiness among rural women of reproductive age in Nigeria

Article Title: Knowledge, perceived benefits and willingness to adopt telehealth among women of reproductive age attending selected rural primary health care centres in Ibadan, Oyo State, Nigeria

Article References: Knowledge, perceived benefits and willingness to adopt telehealth among women of reproductive age attending selected rural primary health care centres in Ibadan, Oyo State, Nigeria. (n.d.). https://doi.org/10.1186/s12913-026-15815-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15815-1

Keywords: telehealth, maternal health, Nigeria, rural health, primary health care, technology acceptance, perceived benefits, women's health, health services research, digital health, reproductive health, Oyo State