Applying the Health Belief Model to Explain Male Decision-Making on Childbirth Location in Rural Nigerian Communities
Abstract
Background: Men often control household resources and influence decisions about where women give birth in rural Nigeria, yet their choices are rarely examined through a behavioural framework. Objective: This study applied the Health Belief Model (HBM) to explain how perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy shaped men’s support for facility-based child-birth. Methods: A theory-guided secondary interpretation was conducted using data from a concurrent triangulation mixed-methods study in rural communities of Akwanga, Keffi and Lafia Local Government Areas of Nasarawa State. The original study included a survey of 443 men, 12 focus group discussions, 70 key informant interviews, and 21 in-depth interviews. Quantitative findings were summarized descriptively and through reported chi-square associations, while qualitative themes were mapped to HBM constructs. Results: Although 95.3% of respondents were aware of safe delivery practices and 91.4% preferred facility delivery, cost was the leading reported barrier (74.7%). Cultural tradition, trust in traditional birth attendants, and lower cost continued to favour home delivery. Men recognized haemorrhage, infection, prolonged labour and death as serious outcomes, but previous uncomplicated home births reduced perceived susceptibility. Education was associated with knowledge of safe delivery (χ²=31.48, p=0.0001), occupation with attitudes toward home delivery (χ²=34.15, p=0.0072), and income with preferred delivery location (χ²=31.98, p=0.0011). Health workers, community leaders, prior complications, and health education acted as cues to action. Men’s capacity to mobilize money, transport and emergency support represented practical self-efficacy. Conclusions: The HBM explains an important part of male decision-making, particularly the gap between recognising the benefits of skilled attendance and acting when barriers are immediate. Its explanatory reach improves when household power, poverty, service quality and transport are treated as contextual forces rather than individual beliefs alone.