Project – Assessment of the Effect of Health Education on Preventive Health Practices Among Adults in Selected Communities in Ikeja

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Health is a fundamental component of human well-being, productivity and social development. The health status of individuals and communities is influenced not only by the availability of curative medical services but also by the extent to which people possess the knowledge, attitudes and skills required to prevent diseases and promote healthy living. In contemporary public health, increasing attention is therefore being directed towards health promotion, disease prevention, health literacy and community participation. Primary health care places considerable emphasis on empowering individuals, families and communities to take responsibility for their health and to adopt behaviours that reduce exposure to preventable health risks (World Health Organization [WHO], 2022, 2025).

Health education is an important instrument for achieving these objectives. It involves planned learning experiences through which individuals and groups acquire health-related knowledge, develop appropriate attitudes and acquire skills that can facilitate healthier decisions and behaviours. Health education may be provided through health talks, community outreach, interpersonal counselling, group discussions, public campaigns, mass media, schools, religious organisations, health facilities and increasingly through digital platforms. Its ultimate purpose is not merely to provide information but to enable individuals to understand health risks and translate health information into appropriate action.

The importance of health education has become more pronounced because many health problems confronting populations are associated with modifiable behavioural and environmental factors. According to the WHO, major behavioural risk factors for non-communicable diseases include tobacco use, unhealthy diets, harmful alcohol consumption and insufficient physical activity. These behaviours contribute to metabolic risk factors such as raised blood pressure, overweight and obesity, elevated blood glucose and abnormal blood lipids (WHO, 2025). Consequently, effective health education can contribute to disease prevention by helping individuals understand these risks and encouraging them to adopt healthier lifestyles.

Preventive health practices encompass a wide range of actions undertaken by individuals to prevent illness, detect diseases at an early stage and maintain good health. Such practices include regular physical activity, balanced nutrition, adequate personal and environmental hygiene, appropriate use of health services, immunisation where applicable, periodic medical examinations, screening for diseases, avoidance of tobacco and harmful alcohol use, safe sexual practices, adherence to recommended medication and early healthcare seeking. Preventive practices can therefore occur before disease develops or during the early stages of a condition when intervention is more effective.

The relationship between health information and preventive behaviour is closely connected with the concept of health literacy. WHO defines health literacy in terms of people’s ability to access, understand, appraise and use health information and services in ways that promote and maintain health and well-being (WHO, 2025). Health education can strengthen this capacity by providing individuals with understandable and actionable information. However, knowledge alone does not automatically result in healthy behaviour. Individual beliefs, cultural norms, socioeconomic circumstances, accessibility of health services, family influences, perceived susceptibility to illness and trust in health information can determine whether knowledge is translated into practice.

Evidence from health research demonstrates that health literacy and preventive practices are related, although the relationship can vary across population groups. White, Chen, and Atchison (2008), in a national study involving 18,100 adults in the United States, found that low health literacy was associated with a lower likelihood of engaging in several preventive health practices among older adults. Their findings demonstrate the importance of considering individuals’ ability to understand and apply health information when examining preventive behaviour.

Similarly, systematic evidence indicates that health education and health literacy interventions can influence health-related knowledge, attitudes and behaviours. A systematic review and meta-analysis of health education interventions among adults with selected non-communicable diseases in low- and middle-income countries found significant effects on disease knowledge, attitudes and health-related behaviour (Winkley et al., 2021). The review, which included 53 studies, concluded that health-literacy interventions can support primary and secondary prevention of important chronic diseases. These findings provide a strong basis for examining whether health education is similarly associated with preventive practices among adults within specific Nigerian communities.

The Nigerian context makes the subject particularly important. Nigeria faces a dual burden of communicable and non-communicable diseases, while health-seeking behaviour and the utilisation of preventive services remain affected by socioeconomic, cultural, educational and health-system factors. The Nigeria Demographic and Health Survey provides extensive evidence on population health and healthcare-related behaviours across the country (National Population Commission [NPC] & ICF, 2019). At the same time, the WHO’s assessment of Nigeria’s primary health care system emphasises the importance of integrated health services, multisectoral action and community empowerment in improving health outcomes (WHO, 2024).

Health literacy has also been identified as an important challenge in Nigeria. Adekoya-Cole et al. (2015) observed that factors such as cultural and belief systems, ineffective communication, low educational attainment and socioeconomic circumstances can affect health literacy in Nigeria. Poor health literacy may consequently contribute to difficulties in understanding health information and making appropriate decisions concerning preventive services. This is particularly important in communities where health information may be obtained from a mixture of formal health professionals, family members, religious institutions, social media and informal sources.

Evidence from Lagos further reinforces the relevance of community-based health education. Liu et al. (2020) assessed health literacy, health behaviours and access to health resources in informal settlements around Lagos. The study highlighted the need for community health education and identified health literacy and behavioural practices as important areas for intervention in underserved urban communities. This is significant because Lagos is a highly urbanised and socially diverse environment in which access to information and healthcare can differ considerably across communities.

Ikeja, as one of the prominent urban areas of Lagos State, provides an important setting for investigating health education and preventive practices among adults. Adults in urban communities are exposed to multiple health influences arising from occupational demands, sedentary lifestyles, dietary patterns, environmental conditions, stress, commercial activities and varying levels of access to healthcare. Urban residence does not necessarily guarantee appropriate preventive health behaviour. Individuals may possess information about diseases but fail to undertake routine screening, engage in adequate physical activity, maintain healthy diets or seek healthcare promptly.

The adult population is particularly important in preventive health research because adulthood encompasses a period when many chronic health risks accumulate. Hypertension, diabetes, cardiovascular diseases, obesity and some cancers may develop gradually without obvious symptoms. Preventive measures such as blood-pressure checks, blood-glucose screening, healthy dietary practices, physical activity and early healthcare seeking can therefore play an important role in reducing avoidable morbidity. The WHO identifies cardiovascular diseases, cancers, diabetes and chronic respiratory diseases as major non-communicable diseases and stresses the importance of addressing their behavioural and metabolic risk factors (WHO, 2022, 2025).

Health education can assist adults in recognising the importance of preventive actions before symptoms become severe. For example, an adult who understands the risk factors for hypertension may be more willing to reduce salt intake, engage in physical activity, monitor blood pressure and seek medical advice. Similarly, an adult who receives appropriate information about diabetes may be more conscious of diet, weight management, physical activity and routine screening. Thus, health education can potentially transform preventive health practices from occasional responses to illness into regular components of everyday life.

Empirical studies in Nigeria have demonstrated that targeted health education can produce improvements in specific preventive behaviours. Ozoemena et al. (2019), in a study of Nigerian retirees, found that a community-based health education intervention significantly improved hypertension knowledge, physical activity, sleep patterns, substance-use abstinence, healthy diet and medication adherence among participants in the intervention group. The researchers concluded that community-based health education could improve hypertension prevention and self-care practices among older adults.

Evidence is also available from Lagos concerning the role of health education in preventive health behaviour. A study conducted among nursing mothers in Ikeja Local Government Area examined the effect of health education delivered by primary healthcare workers on oral health knowledge and practices. The intervention was specifically undertaken in Ikeja and evaluated changes in preventive oral-health knowledge and practices (Adeniyi et al., 2018). This provides locally relevant evidence that structured health education can be used to improve preventive practices within communities in Ikeja.

Other Nigerian studies have demonstrated the potential contribution of community health educators to preventive service utilisation. Chigbu et al. (2017), for instance, investigated the impact of trained community health educators on the uptake of cervical and breast cancer prevention services in Nigerian communities. The study focused on screening and HPV vaccination and demonstrated the relevance of trained community educators in promoting preventive health services.

Despite these findings, there remains a need to examine health education and preventive practices at the community level because health behaviour is shaped by local social and environmental circumstances. Health education messages may be available, but adults may not necessarily receive them consistently, understand them adequately or apply them in their daily lives. Moreover, access to health information through television, radio, social media and healthcare facilities does not necessarily imply that adults engage in appropriate preventive practices.

The WHO’s contemporary approach to health literacy recognises that people make health decisions within social, cultural, organisational and political environments. Consequently, improving health literacy requires more than simply giving individuals information; health information must be accessible, understandable, trustworthy and actionable (WHO, 2022, 2025). This perspective is particularly relevant to community-based research because preventive behaviour can be influenced by family norms, cultural beliefs, community expectations and the availability and affordability of health services.

Primary health care provides an appropriate framework for connecting health education with preventive practices. WHO describes primary health care as a whole-of-society approach that brings health services closer to people’s everyday environments while addressing health promotion, disease prevention, treatment and rehabilitation (WHO, 2025). Community-based health education is therefore not an isolated activity but part of a broader strategy for empowering individuals and communities to participate actively in maintaining their health.

The importance of community engagement has also been highlighted in the development of resilient health systems. Rajan et al. (2023) noted that community engagement is essential to primary health care because it can improve trust, address inequalities and strengthen the ability of health systems to respond to community needs. Health education that is culturally appropriate, participatory and connected to local health needs may therefore have greater potential to influence preventive behaviour than information delivered without consideration of community circumstances.

Against this background, assessing the effect of health education on preventive health practices among adults in selected communities in Ikeja is important. The study seeks to establish whether exposure to health education is associated with better preventive practices among adults and to identify areas in which health education may contribute to healthier behaviour. The findings may provide useful evidence for community health educators, primary healthcare providers, public health practitioners and policymakers seeking to strengthen disease-prevention strategies in Ikeja and similar urban communities in Lagos State.

1.2 Statement of the Problem

Preventable diseases continue to constitute an important public health concern despite advances in medical knowledge, healthcare services and health information technology. Many illnesses can be reduced or detected early through appropriate preventive practices, including healthy nutrition, regular physical activity, personal and environmental hygiene, routine screening, immunisation, avoidance of harmful substances and timely utilisation of healthcare services. Nevertheless, the availability of preventive knowledge does not always translate into preventive action.

One major concern is the gap between health knowledge and health behaviour. Adults may have heard messages about hypertension, diabetes, cancer, infectious diseases, healthy diets, exercise and routine medical examinations but may not consistently practise what they know. Some individuals may only seek medical care when symptoms become severe rather than undertaking routine preventive checks. Others may disregard screening because they perceive themselves as healthy or because they believe that healthcare facilities should primarily be used for treatment rather than prevention.

The problem is compounded by inadequate health literacy. In Nigeria, poor health literacy has been associated with limited understanding and utilisation of preventive health services, with cultural beliefs, communication difficulties, educational level and socioeconomic circumstances identified as relevant factors (Adekoya-Cole et al., 2015). Consequently, simply increasing the amount of health information available to adults may not be sufficient unless the information is understandable, relevant and capable of being converted into practical decisions.

The growing burden of non-communicable diseases makes this problem more urgent. Behavioural factors such as unhealthy diets, physical inactivity, tobacco use and harmful alcohol consumption contribute substantially to NCD risk (WHO, 2025). Adults who do not engage in preventive practices may therefore remain exposed to avoidable health risks for long periods before a disease is diagnosed. This can result in increased healthcare costs, reduced productivity, complications and premature mortality.

In urban communities such as those in Ikeja, the problem may assume additional dimensions. Urban adults may experience demanding work schedules, sedentary occupations, transportation-related constraints, dietary changes, psychosocial stress and extensive exposure to commercial health information. Although health facilities and information sources may be relatively accessible, accessibility does not automatically guarantee effective utilisation of preventive services. Some adults may prioritise work and family responsibilities over routine health checks, while others may postpone healthcare until illness interferes with daily activities.

Another concern is the quality and consistency of health information available to adults. The increasing use of social media and digital platforms has expanded access to health information but has also increased exposure to misinformation and unverified health claims. Adults may receive contradictory messages concerning diet, medication, screening, disease prevention and treatment. WHO emphasises that health literacy involves not only accessing information but also the ability to understand and appraise information before using it to make health decisions (WHO, 2025).

The evidence from Lagos demonstrates that health education remains relevant to improving community health behaviour. Liu et al. (2020) found important health literacy and behavioural issues among residents of informal settlements around Lagos and recommended attention to community health education. Similarly, evidence from Ikeja indicates that health education delivered through primary healthcare workers can improve specific preventive health knowledge and practices (Adeniyi et al., 2018). However, such evidence is often concentrated on particular health conditions or population groups rather than on preventive health practices broadly among adults.

There is therefore a need to examine the extent to which health education influences the general preventive health behaviour of adults in selected communities in Ikeja. It is important to determine whether adults who receive health education demonstrate better preventive practices than those with lower exposure to health education. Without such evidence, community health education programmes may continue to be implemented without sufficient understanding of their relationship with actual behavioural outcomes.

The problem addressed by this study is therefore the apparent gap between the availability of health education and the adoption of preventive health practices among adults. Although health education is expected to improve health knowledge and encourage healthier behaviour, the extent to which this occurs among adults in selected communities in Ikeja requires empirical assessment. The study consequently investigates whether health education has a significant effect on preventive health practices among adults in the selected communities.

1.3 Aim of the Study

The main aim of this study is to assess the effect of health education on preventive health practices among adults in selected communities in Ikeja, Lagos State.

1.4 Objectives of the Study

The specific objectives are to:

1. assess the level of exposure of adults in selected communities in Ikeja to health education;
2. determine the level of preventive health practices among adults in the selected communities;
3. examine the major sources through which adults in the selected communities receive health education;
4. assess the relationship between health education and preventive health practices among adults in the selected communities; and
5. determine whether health education has a significant effect on preventive health practices among adults in the selected communities.

1.5 Research Questions

The following research questions will guide the study:

1. What is the level of exposure of adults in selected communities in Ikeja to health education?
2. What is the level of preventive health practices among adults in the selected communities?
3. What are the major sources through which adults in the selected communities receive health education?
4. What relationship exists between health education and preventive health practices among adults in the selected communities?
5. Does health education have a significant effect on preventive health practices among adults in the selected communities?

1.6 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: Health education has no significant effect on preventive health practices among adults in selected communities in Ikeja, Lagos State.

1.7 Significance of the Study

The study will be significant to public health practitioners because it will provide evidence on whether health education contributes to the adoption of preventive health behaviours among adults. The findings may help community health educators identify areas in which existing health education programmes are effective and areas requiring improvement.

The study will also be useful to primary healthcare providers in Ikeja. Evidence on adults’ preventive practices may assist healthcare workers in designing more responsive community outreach programmes. Rather than concentrating primarily on curative services, healthcare workers may use the findings to strengthen health promotion, screening, counselling and disease-prevention activities.

The study will be valuable to the Lagos State Government and other policymakers responsible for public health planning. Findings may provide empirical information for strengthening community-based health education programmes and improving preventive health service utilisation. This is consistent with the primary healthcare approach, which emphasises health promotion, disease prevention and community empowerment (WHO, 2025).

Adults in the selected communities may also benefit from the study because it may increase awareness of the importance of preventive health practices. The research may draw attention to behaviours such as regular health checks, appropriate nutrition, physical activity, personal hygiene, avoidance of harmful substances and early healthcare seeking.

The study will also be useful to community leaders, religious organisations, non-governmental organisations and other groups involved in community development. Such organisations frequently serve as channels through which health messages can reach adults. The findings may encourage greater collaboration between community structures and healthcare providers in delivering accurate, culturally appropriate and practical health education.

Academically, the study will contribute to the body of literature on health education, health literacy and preventive health behaviour in Nigeria. Existing Nigerian studies have examined specific areas such as hypertension prevention, oral health and cancer screening, but there remains value in examining the broader relationship between health education and preventive practices among adults within an urban Lagos context.

Finally, the study will provide a useful reference for future researchers who may wish to investigate health education, health literacy, preventive behaviour, community health promotion or primary healthcare utilisation in Lagos State and other Nigerian urban communities.

1.8 Scope of the Study

The study focuses on the assessment of the effect of health education on preventive health practices among adults in selected communities in Ikeja, Lagos State.

The study will concentrate on two major variables. The independent variable is health education, while the dependent variable is preventive health practices. Health education will be examined in relation to exposure, sources, frequency, content and perceived usefulness of health information. Preventive health practices will cover areas such as healthy dietary behaviour, physical activity, personal and environmental hygiene, routine health checks and screening, appropriate healthcare seeking, avoidance of harmful substances and other relevant disease-prevention behaviours.

Geographically, the study is restricted to selected communities within Ikeja. The target population comprises adults aged 18 years and above residing in the selected communities. The study is not intended to provide a comprehensive assessment of all health conditions affecting adults in Lagos State; rather, it focuses specifically on the relationship between health education and preventive health practices.

1.9 Operational Definition of Terms

Adult: For the purpose of this study, an adult refers to an individual aged 18 years and above who resides in one of the selected communities in Ikeja.

Health Education: Planned educational activities through which individuals and communities receive health information and develop knowledge, attitudes and skills intended to promote healthy behaviour and prevent disease.

Health Literacy: The ability of individuals to access, understand, evaluate and use health information and health services to make appropriate decisions concerning their health.

Preventive Health Practices: Actions undertaken by individuals to prevent disease, reduce health risks, maintain good health or detect disease at an early stage. These include healthy eating, physical activity, screening, routine medical checks, hygiene, immunisation where applicable, avoidance of harmful substances and early healthcare seeking.

Health Promotion: Activities and processes that enable individuals and communities to improve control over factors affecting their health and consequently improve their health and well-being.

Disease Prevention: Measures undertaken to reduce the occurrence, progression or consequences of diseases and other health problems.

Community: A geographically defined group of people living within a particular area and sharing social, environmental or institutional characteristics.

Preventive Health Behaviour: Observable actions or practices adopted by individuals to reduce their risk of illness and promote continued health and well-being.

Health Information: Knowledge, facts, guidance or messages concerning diseases, health risks, healthcare services and behaviours that promote or protect health.

Effect: The measurable influence or outcome associated with exposure to health education on the preventive health practices of adults in the study area.

Project – Assessment of the Effect of Health Education on Preventive Health Practices Among Adults in Selected Communities in Ikeja