Telemedicine and mobile clinical entrepreneurship as catalysts for healthcare access in Benin city, Nigeria: a sequential explanatory mixed-methods study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20262223Keywords:
Benin city, Digital health, Healthcare access, Mobile clinical entrepreneurship, Mobile clinics, TelemedicineAbstract
Background: Healthcare access in Benin City, Nigeria is constrained by inadequate infrastructure, workforce shortages, and high out-of-pocket costs. Telemedicine and mobile clinical entrepreneurship represent viable delivery innovations, yet their comparative effectiveness and sustainability remain insufficiently understood.
Methods: A sequential explanatory mixed-methods design was employed. Quantitative data were collected from 287 adults using a structured questionnaire and analysed with descriptive statistics, chi-square tests, ANOVA, and logistic regression. Qualitative data were obtained through in-depth interviews with 28 key informants and analysed thematically; findings were integrated at the interpretation stage.
Results: Mobile clinics demonstrated stronger access outcomes, with greater reductions in travel time (66.7% vs 53.3%, p<0.001) and waiting time (71.1% vs 46.7%, p=0.013), alongside higher satisfaction (mean 3.5 vs 2.9). Adjusted odds of reporting travel-time reduction were higher for mobile clinic users (AOR 14.8, 95% CI 5.9 to 37.1) than telemedicine users (AOR 7.3, 95% CI 2.9 to 18.6). Telemedicine showed a comparative advantage for chronic disease management. Awareness remained low, with 75% of respondents unaware of any telemedicine service. Key barriers included poor infrastructure, limited training, and low insurance coverage.
Conclusions: Both models improve healthcare access through complementary mechanisms. Mobile clinics effectively address geographic barriers while telemedicine supports chronic care continuity. Infrastructure investment, clinical training, and sustainable financing are critical prerequisites for long-term integration.
References
Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, et al. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet. 2022;399(10330):1155-1200.
Wambebe NM, Duan X. Health infrastructural deficit in Nigeria: the time to act is now. Cent Afr J Public Health. 2022;8(5):203-12.
Okeke C, Ezenwaka U, Ekenna A. Analysing progress in service delivery towards universal health coverage in Nigeria: a scoping review. BMC Health Serv Res. 2023;23:1094.
Abah VO. Poor health care access in Nigeria: a function of fundamental misconceptions. In: Healthcare Access. London: IntechOpen; 2022.
Agbonlahor O. Crisis of brain drain in Nigeria's health sector. PMC. 2024.
MacroTrends. Benin City, Nigeria metro area population 1950-2026 [Internet]. 2023.
Oyinlola I, et al. Role of digital health technologies in improving health financing in sub-Saharan Africa. Front Digit Health. 2025.
Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017;377(16):1585-92.
Shaver J. The state of telehealth before and after the COVID-19 pandemic. Prim Care Clin Off Pract. 2022;49(4):517-30.
World Health Organization. Global strategy on digital health 2020-2025, 2021. Available at: https://www.who.int/publications/i/item/9789240020924. Accessed 01 January 2026.
Cole OK, Abubakar MM, Isah A, Sule SH, Ukoha-Kalu BO. Barriers and facilitators of provision of telemedicine in Nigeria: A systematic review. PLOS Digital Health. 2025;4(7):e0000934.
Rabiou LM, Oumarou B, Mor D, Abdou M, Ibrahim C, Tamuzi JL, et al. Mobile outreach clinics for improving health care services accessibility in vulnerable populations of the Diffa Region in Niger: a descriptive study. Int J Equity in Health. 2024;23(1):235.
Nkosi MZ. Patients’ experiences in the use of mobile health clinics in KwaMachi rural area of KwaZulu-Natal, South Africa. Dialogues in Health. 2024;4:100164.
Dodoo JE, Al-Samarraie H, Alzahrani AI. Telemedicine use in sub-Saharan Africa: barriers and policy recommendations. Int J Med Inform. 2022;160:104707.
Agbeyangi AO, Lukose JM. Telemedicine adoption and prospects in sub-Sahara Africa: a systematic review with a focus on South Africa, Kenya, and Nigeria. InHealthcare 2025;13)(7):762.
Shekoni O, Iversen S, Diaz GJ, Aune A, Ubuane PO, Imam Z, André B. Healthcare workers’ perceptions about the use of mobile health technologies in public health facilities in Lagos, Nigeria. SAGE Open Medic. 2024;12:20503121231224568.
Egwudo AE, Jegede AO, Oyeniyi TA, Ezekwelu NJ, Abdu-Aguye SN, Okwuraiwe AP, et al. Integrating digital health technologies into the healthcare system: Challenges and opportunities in Nigeria. PLOS Digital Health. 2025;4(7):e0000928.
The Guardian. Edo boosts healthcare delivery across three senatorial districts. The Guardian Nigeria; 2025 Jul 5. Available at: https://guardian.ng/news/nigeria/metro/edo-boosts-healthcare-delivery-across-three-senatorial-districts/. Accessed 01 January 2026.
Creswell JW, Creswell JD. Research design: qualitative, quantitative, and mixed methods approaches. 5th ed. Thousand Oaks, CA: SAGE; 2018.
Curry LA, Krumholz HM, O’Cathain A, Clark VL, Cherlin E, Bradley EH. Mixed methods in biomedical and health services research. Circ Cardiovasc Qual Outcomes. 2013;6(1):119-23.
Ivankova NV, Creswell JW, Stick SL. Using mixed-methods sequential explanatory design. Field Methods. 2006;18(1):3-20.
Morgan DL. Paradigms lost and pragmatism regained. J Mix Methods Res. 2007;1(1):48-76.
Fleiss JL, Levin B, Paik MC. Statistical methods for rates and proportions. 3rd ed. Hoboken, NJ: Wiley; 2003.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.
Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q. 1989;13(3):319-40.
Champion VL, Skinner CS. The health belief model. In: Glanz K, et al., editors. Health behavior and health education. 4th ed. San Francisco, CA: Jossey-Bass; 2008:45-65.
Davalos ME, et al. Digital age satisfaction: a systematic review of patient satisfaction with telemedicine. Telemed J E Health. 2009;15(2):112-23.
Lynn MR. Determination and quantification of content validity. Nurs Res. 1986;35(6):382-5.
Nunnally JC. Psychometric theory. 2nd ed. New York, NY: McGraw-Hill; 1978.
Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, et al. Multiple imputation for missing data in epidemiological research. BMJ. 2009;338:b2393.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.
Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs. Health Serv Res. 2013;48(6 Pt 2):2134-56.
Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, CA: SAGE; 1985.
Federal Ministry of Health. National code of health research ethics, 2007. Available at: https://healthresearchwebafrica.org.za/files/NCHRECurrentVersion.pdf. Accessed 01 January 2026.
Paré G, Moqadem K, Pineau G, St-Hilaire C. Clinical effects of home telemonitoring for diabetes, asthma, heart failure and hypertension. J Med Internet Res. 2010;12(2):e21.
Agyekum EA, et al. Challenges and prospects of telemedicine in Ghana: a scoping review. Pan Afr Med J. 2021;40:57.
Adepoju OE. Public trust and telehealth adoption in Nigeria. J Telemed Telecare. 2022;28(3):210-8.
Dees JG. The meaning of social entrepreneurship. Durham, NC: Duke University; 1998.
Rogers EM. Diffusion of innovations. 5th ed. New York, NY: Free Press; 2003.
Rosenstock IM. The health belief model and preventive health behavior. Health Educ Monogr. 1974;2(4):354-86.
Downloads
Published
How to Cite
Issue
Section
