AbstractHealthcare service utilization among university students is critical for ensuring their health and academic success. This study was performed to determine the level of utilization as well as the perception and factors influencing the utilization of healthcare services by students at Afe Babalola University, Ado-Ekiti (ABUAD).

摘要大学生对医疗保健服务的利用对于确保他们的健康和学业成功至关重要。这项研究的目的是确定阿多埃基蒂（ABUAD）Afe巴巴洛拉大学（Afe Babalola University）学生利用医疗服务的水平以及影响其利用医疗服务的感知和因素。

This research involved a cross-sectional survey in which a semi-structured online questionnaire was used to collect data and a multistage sampling technique was used to sample the students. The students’ perceptions were converted to scores by summing their responses across the questions. The total score for each student was compared against the midpoint of the possible score range.

这项研究涉及一项横断面调查，其中使用半结构化在线问卷收集数据，并使用多阶段抽样技术对学生进行抽样。学生的看法通过对问题的回答进行总结而转化为分数。将每个学生的总分与可能得分范围的中点进行比较。

Perceptions with a total score greater than or equal to 12.5 were categorized as positive, while those with a total score less than 12.5 were categorized as negative. Logistic regression analysis was used to identify predictors of healthcare service utilization. Utilization of healthcare services, the key outcome variable, was defined as the frequency with which students accessed available health services.

总分大于或等于12.5的感知被归类为积极，而总分小于12.5的感知被归类为消极。Logistic回归分析用于确定医疗服务利用的预测因子。。

All analyses were carried out using Statistical Product and Service Solutions (SPSS) software. A total of 429 students participated in this study, majority of whom were females (304, 70.9%), with a mean age of 18.9 ± 1.7 years. Three hundred and seventy-five students (87.4%) reported utilizing healthcare services at the university of which 186 (43.4%) reported to occasionally utilize healthcare services in the university.

所有分析均使用统计产品和服务解决方案（SPSS）软件进行。共有429名学生参加了这项研究，其中大多数是女性（304人，70.9%），平均年龄为18.9±1.7岁。375名学生（87.4%）报告在大学使用医疗服务，其中186名（43.4%）报告偶尔在大学使用医疗服务。

A total of 33.1% perceived that the attitude of staff was poor, while 12.6% strongly disagreed that the healthcare staff were incompetent. Overall, the majority (287, 66.9%) of the students had a negative perception of the utilization of heal.

共有33.1%的人认为工作人员的态度很差，而12.6%的人强烈不同意医护人员不称职。总体而言，大多数学生（287人，66.9%）对heal的使用持负面看法。

IntroductionHealthcare systems are designed to address the health needs of specific populations, requiring a robust funding mechanism, a skilled workforce, reliable information for decision-making, and well-equipped facilities. Optimal health is essential for a productive social and economic life, making effective and safe healthcare services crucial1.University students’ health services are vital given the global increase in tertiary enrollment2.

简介医疗保健系统旨在满足特定人群的健康需求，需要强大的资金机制，熟练的劳动力，可靠的决策信息以及设备齐全的设施。最佳健康对于富有成效的社会和经济生活至关重要，因此有效和安全的医疗保健服务至关重要。鉴于全球高等教育入学人数的增加，大学生的医疗保健服务至关重要。

High-quality health services directly enhance students’ health and welfare and indirectly improve academic success3. Health issues can impact students’ learning, quality of life, and relationships both during their academic careers and after graduation, with potential long-term effects on their well-being and academic progress4,5,6,7,8,9,10,11.The utilization of health services is influenced by several factors: accessibility, quality of services, and client preferences, which are shaped by past experiences, beliefs, health status, and socioeconomic factors12.

高质量的卫生服务直接提高了学生的健康和福利，间接提高了学业成绩3。健康问题会影响学生在学术生涯中和毕业后的学习，生活质量和人际关系，对他们的幸福感和学业进步产生潜在的长期影响4,5,6,7,8,9,10,11。卫生服务的利用受到几个因素的影响：可及性，服务质量和客户偏好，这些因素由过去的经验，信仰，健康状况和社会经济因素决定12。

Common health issues among university students, such as anxiety, depression, eating disorders, and substance abuse, pose significant challenges. Students who do not seek treatment are at higher risk of academic failure, substance abuse, and even suicide13. Research highlights that health issues negatively impact students’ learning, quality of life, and relationships, potentially leading to long-term consequences for their overall health and future success14.In Nigeria, healthcare services are provided by the government, private organizations, and universities.

大学生常见的健康问题，如焦虑、抑郁、饮食失调和药物滥用，构成了重大挑战。。研究强调，健康问题对学生的学习、生活质量和人际关系产生负面影响，可能对他们的整体健康和未来成功产生长期影响14。在尼日利亚，医疗保健服务由政府、私人组织和大学提供。

However, utilization among university students is relatively low due to factors such as financial constraints, lack of awareness, and perceptions of service quality15. Additional factors, including religious beliefs.

然而，由于经济拮据，缺乏意识和对服务质量的看法等因素，大学生的利用率相对较低15。其他因素，包括宗教信仰。

Stage 1:

第一阶段：

Computer-generated codes were used for a simple random sampling technique to select four out of the six colleges at ABUAD. The decision not to include higher-level sampling, such as faculties, was based on the university’s organizational structure, which comprises colleges and departments.

计算机生成的代码被用于一种简单的随机抽样技术，从阿布阿德的六所大学中选出四所。不包括院系等更高层次抽样的决定是基于大学的组织结构，其中包括学院和院系。

Stage 2:

第二阶段：

Two departments were selected from each college using a simple random sampling technique of computer-generated codes. This method ensured that each department had an equal and unbiased chance of being selected.. This approach was taken because each college at ABUAD typically includes a minimum of two departments except the College of Law which has one department.

使用计算机生成代码的简单随机抽样技术，从每所大学中选择了两个系。这种方法确保每个部门都有平等和公正的机会被选中。。之所以采用这种方法，是因为阿布阿德的每所学院通常至少包括两个系，只有一个系的法学院除外。

Proportionate allocation was then used to determine the number of students to be sampled from each department based on their relative sizes within the college (Table 1). Within each department, students were randomly selected to participate in the study. This was done by assigning numbers to all students in the department and using a random number generator to select the required number of participants.

然后使用比例分配来确定根据学院内相对规模从每个部门抽样的学生人数（表1）。在每个部门内，随机选择学生参加研究。这是通过为该系的所有学生分配数字并使用随机数字生成器来选择所需的参与者数量来完成的。

The link to the online questionnaire was shared with the selected students from each department..

在线问卷的链接已与每个系的选定学生共享。。

To ensure the validity of responses, rigorous efforts were made to restrict the questionnaire’s access to eligible individuals and they include;

为了确保答复的有效性，我们做出了严格的努力，限制合格个人获得问卷，其中包括：；

Access control:

访问控制：

The online questionnaire was distributed via a Google Forms link accessible only to students from the selected departments. Access was restricted to ensure that only eligible participants could respond.

在线问卷是通过谷歌表单链接分发的，只有来自选定部门的学生才能访问。访问受到限制，以确保只有符合条件的参与者才能做出回应。

Verification:

验证：

Participants were required to verify their student status before proceeding with the questionnaire, ensuring that only current ABUAD students were included in the study.

参与者被要求在进行问卷调查之前验证他们的学生身份，确保只有目前的ABUAD学生被纳入研究。

Response limits:

响应限制：

The Google Forms link was programmed to automatically stop accepting responses once the predetermined number of participants from each department was reached. This measure helped maintain sample integrity and data reliability.

谷歌表单链接被编程为一旦达到每个部门预定的参与者人数，就会自动停止接受回复。这一措施有助于保持样本的完整性和数据的可靠性。

Table 1 Proportionate allocation of sample size based on colleges and departments breakdown.Full size tableInstrument for data collectionA 21-item semi-structured questionnaire was designed to address the study’s objectives. The survey comprised four sections: socio-demographics, utilization of healthcare services, students’ perceptions, and economic factors affecting healthcare utilization.

表1基于学院和院系细分的样本量比例分配。用于数据收集的全尺寸表格工具设计了一份21项半结构化问卷来解决研究的目标。该调查包括四个部分：社会人口统计学，医疗保健服务的利用，学生的看法以及影响医疗保健利用的经济因素。

The questionnaire included multiple-choice, Likert scale, and binary response questions.The first section assessed the socio-demographics of the participants, gathering information on age, sex, marital status, and religion. Section B assessed the utilization of healthcare services among ABUAD students, using three questions that included yes/no and multiple-choice formats.Section C assessed the students’ perception towards the utilization of healthcare services.

问卷包括多项选择题，李克特量表和二元回答问题。第一部分评估了参与者的社会人口统计数据，收集了有关年龄、性别、婚姻状况和宗教的信息。B部分使用包括是/否和多项选择格式的三个问题评估了ABUAD学生对医疗保健服务的利用情况。C部分评估了学生对医疗服务利用的看法。

This section comprised 5 questions measured using a 4-point Likert scale, where “strongly agree” was the highest rank (assigned a score of 4) and “strongly disagree” was the lowest rank (assigned a score of 1). The students’ perceptions were quantified by summing their responses across five relevant questions.

本节包括使用4分李克特量表测量的5个问题，其中“非常同意”是最高等级（得分为4分），“非常不同意”是最低等级（得分为1分）。学生的看法通过总结他们对五个相关问题的回答来量化。

The possible total score for each student ranged from 5 (if a student selected “strongly disagree” for all questions) to 20 (if a student selected “strongly agree” for all questions). To categorize these perceptions into positive and negative, we compared the total score for each student against the midpoint of the possible score range, which is 12.5.

每个学生的可能总分从5分（如果学生对所有问题选择“非常不同意”）到20分（如果学生对所有问题选择“非常同意”）。为了将这些看法分为正面和负面，我们将每个学生的总分与可能得分范围的中点（12.5）进行了比较。

Perceptions with a total score equal to or greater than 12.5 (more than 50% of the maximum possible score) were categorized as positive, while those with a total score less than 12.5 (less than 50% of the maximum possible score) were categorized as negative… The fourth se.

总分等于或大于12.5（超过最高可能得分的50%）的感知被归类为积极，而总分低于12.5（低于最高可能得分的50%）的感知被归类为消极……第四个se。

Social factors

社会因素

Gender, family size, and age.

性别，家庭规模和年龄。

Perception

感知

Attitudes towards staff, distance of the facility, waiting time, and competence of healthcare staffs.

对员工的态度，设施的距离，等待时间和医护人员的能力。

Economic barriers

经济壁垒

Cost of services, ability to afford food, cost of drugs, family income, and monthly allowance.

服务成本、支付食物的能力、药品成本、家庭收入和每月津贴。

Perception of healthcare services was defined through four key variables: attitudes towards staff, distance of the facility, waiting time, and competence of healthcare staff,. Each variable was measured using a Likert scale. Utilization of health services was defined as visiting the medical center at least once in the past six months.

对医疗服务的感知是通过四个关键变量定义的：对员工的态度，设施的距离，等待时间和医护人员的能力，。使用李克特量表测量每个变量。卫生服务的利用被定义为在过去六个月内至少访问一次医疗中心。

The individual variables were included in the logistic regression analysis to identify significant predictors of healthcare utilization.In analyzing students’ perceptions of healthcare services, it was essential to focus on those who had actual experience with these services. Therefore, students who reported never utilizing the health services at the university medical center were excluded from the perception analysis.

个体变量包括在逻辑回归分析中，以确定医疗保健利用的重要预测因子。在分析学生对医疗保健服务的看法时，必须关注那些有实际服务经验的人。因此，报告从未使用大学医学中心卫生服务的学生被排除在感知分析之外。

This exclusion ensures that the perception analysis accurately reflects the views of those with firsthand experience.Perception factors considered students’ views on the attitude of healthcare staff, the distance of the facility from their hostel, waiting time, and staff competence. Economic barriers included students’ views on the affordability of services and food, the impact of high drug costs, family income across different brackets, and monthly allowances.

这种排除确保了感知分析准确反映了那些有第一手经验的人的观点。感知因素考虑了学生对医护人员态度，设施与宿舍的距离，等待时间和员工能力的看法。。

Also, before the logistic regression analysis the responses of variables for perceptions and economic barriers were dichotomised into agree and disagree.In our study, “economic barriers to utilization of health services” were assessed using three Likert scale questions. These questions asked participants to indicate their level of agreement (ranging from 1 = Strongly Disagree to 4 = Strongly Agree) with statements related to the financial aspects of accessing healthcare services.For the purpose of the binary logistic regression analysis, we categorized the responses i.

此外，在逻辑回归分析之前，变量对感知和经济障碍的反应被分为同意和不同意。在我们的研究中，使用三个李克特量表问题评估了“利用卫生服务的经济障碍”。这些问题要求参与者指出他们对获得医疗保健服务的财务方面的声明的同意程度（从强烈不同意到强烈同意）。为了进行二元逻辑回归分析，我们将响应分类为i。

“Agree” Category: This includes participants who selected “Agree” or “Strongly Agree.“.

“同意”类别：这包括选择“同意”或“非常同意”的参与者。

“Disagree” Category: This includes participants who selected “Disagree” or “Strongly Disagree.”

“不同意”类别：这包括选择“不同意”或“强烈不同意”的参与者

This binary categorization allowed us to create a dichotomous variable for each economic barrier question. In the regression model, we used “Agree” as the reference category. This means that the odds ratios generated from the regression analysis represent the likelihood of facing economic barriers (as defined by disagreement with the statements) compared to the reference group (those who agreed with the statements).Statistical Product and Service Solutions (IBM SPSS) version 27 facilitated the data analysis, with the significance level set at 5%.This study obtained ethical approval from the Afe Babalola University Health Research and Ethics Committee (ABUADHREC) before commencement, with the approval number ABUADHREC/19/05/2023/91.

这种二元分类使我们能够为每个经济障碍问题创建一个二分变量。在回归模型中，我们使用“同意”作为参考类别。这意味着回归分析产生的优势比代表了与参考组（同意声明的人）相比面临经济障碍（由不同意声明定义）的可能性。统计产品和服务解决方案（IBM SPSS）第27版促进了数据分析，显着性水平设置为5%。这项研究在开始之前获得了Afe巴巴洛拉大学健康研究和伦理委员会（ABUADHREC）的伦理批准，批准号为ABUADHREC/19/05/2023/91。

Informed consent was obtained from all subjects and/or their legal guardians, ensuring their voluntary participation. The study was conducted with a strict assurance of confidentiality for all information provided by the participants. Additionally, all methods were carried out in accordance with relevant guidelines and regulations, including the principles outlined in the Declaration of Helsinki.ResultsSociodemographic data of the study participantsA total of 429 students participated in this study, most of whom were females (304, 70.9%) with a mean age of 18.95 ± 1.716 years (range: 14–27 years).

获得了所有受试者和/或其法定监护人的知情同意，确保了他们的自愿参与。这项研究是在严格保证参与者提供的所有信息的机密性的情况下进行的。此外，所有方法均按照相关指南和法规进行，包括《赫尔辛基宣言》中概述的原则。结果研究参与者的社会人口学数据共有429名学生参加了这项研究，其中大多数是女性（304人，70.9%），平均年龄为18.95±1.716岁（范围：14-27岁）。

The majority of the students (388; 90.4%) were Christians, while approximately 1% (5) were married. More than one-quarter (109) were in 200 level, while 53 students (12.4%) were 100 level. More information on the students’ demographics is summarized in Table 2.Utilization and frequency of utilization of healthcare services by ABUAD studentsThree hundred and seventy five (87.4%) students reported utilizing healthcare services at the university (Fig. .

大多数学生（388；90.4%）是基督徒，而大约1%（5）是已婚的。超过四分之一（109人）处于200级，而53名学生（12.4%）处于100级。表2总结了有关学生人口统计学的更多信息。ABUAD学生对医疗保健服务的利用率和利用频率报告了在该大学利用医疗保健服务的375名（87.4%）学生（图）。

Data availability

数据可用性

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

本研究中使用和/或分析的数据集可根据合理要求从通讯作者处获得。

AbbreviationsABUAD:

缩写ABUAD：

Afe Babalola University Ado-Ekiti

埃基蒂Afe Babalola大学

ABUADHREC:

阿布德雷克：

Afe Babalola University Health Research Ethics Committee

Afe巴巴洛拉大学健康研究伦理委员会

WHO:

谁：

World Health Organization

世界卫生组织

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Download referencesAcknowledgementsNot applicable.FundingThe authors did not receive any form of external funding for this research.Author informationAuthors and AffiliationsDepartment of Clinical Pharmacy and Public Health, College of Pharmacy, Afe Babalola University, Ado-Ekiti, Ekiti State, NigeriaEdidiong OrokDepartment of Public Health, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, NigeriaStephanie Nwifama, Olawale Oni, Tolulope Ojo, Tunrayo Oluwadare, Alice Saka, Titilayo Apara & Olasumbo KukoyiDepartment of Mathematical and Physical Sciences, College of Science, Afe Babalola University, Ado-Ekiti, Ekiti State, NigeriaToba Bamitale & Boluwaji JaiyesimiAuthorsEdidiong OrokView author publicationsYou can also search for this author in.

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PubMed Google ScholarContributionsEO, SN and OK conceptualized the study. EO analyzed and interpreted the patient data. SN collected the data from the patients. OO, TO, TOL, BJ, TB, AA, and TA reviewed the manuscript. All authors approved the final version of the manuscript.Corresponding authorCorrespondence to.

PubMed谷歌学术贡献SEO，SN和OK将这项研究概念化。EO分析并解释了患者数据。。OO，TO，TOL，BJ，TB，AA和TA审阅了手稿。所有作者都批准了手稿的最终版本。对应作者对应。

Edidiong Orok.Ethics declarations

Edidiong Orok。道德宣言

Ethics approval and consent to participate

道德批准和同意参与

This study obtained ethical approval from the Afe Babalola University Health Research and Ethics Committee (ABUADHREC) before commencement, with the approval number ABUADHREC/19/05/2023/91. Informed consent was obtained from all subjects and/or their legal guardians, ensuring their voluntary participation.

这项研究在开始之前获得了Afe巴巴洛拉大学健康研究和伦理委员会（ABUADHREC）的伦理批准，批准号为ABUADHREC/19/05/2023/91。获得了所有受试者和/或其法定监护人的知情同意，确保了他们的自愿参与。

The study was conducted with a strict assurance of confidentiality for all information provided by the participants. Additionally, all methods were carried out in accordance with relevant guidelines and regulations, including the principles outlined in the Declaration of Helsinki..

这项研究是在严格保证参与者提供的所有信息的机密性的情况下进行的。此外，所有方法均按照相关指南和法规进行，包括《赫尔辛基宣言》中概述的原则。。

Competing interests

相互竞争的利益

The authors declare no competing interests.

作者声明没有利益冲突。

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Reprints and permissionsAbout this articleCite this articleOrok, E., Nwifama, S., Oni, O. et al. Students’ perception of healthcare services and factors affecting their utilization at a Nigerian University: a cross-sectional study.

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Sci Rep 14, 23893 (2024). https://doi.org/10.1038/s41598-024-75573-0Download citationReceived: 21 January 2024Accepted: 07 October 2024Published: 12 October 2024DOI: https://doi.org/10.1038/s41598-024-75573-0Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

科学报告1423893（2024）。https://doi.org/10.1038/s41598-024-75573-0Download引文接收日期：2024年1月21日接受日期：2024年10月7日发布日期：2024年10月12日OI：https://doi.org/10.1038/s41598-024-75573-0Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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KeywordsPerceptionFactorsHealthcare services utilizationUndergraduatesNigeria

关键词选择因素医疗服务利用率本科生老年人