Socio-economic and Healthcare Determinants of Health Insurance Awareness and Enrollment in Ilorin, Nigeria

Socio-economic and Healthcare Determinants of Health Insurance Awareness and Enrollment in Ilorin, Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Socio-economic and Healthcare Determinants of Health Insurance Awareness and Enrollment in Ilorin, Nigeria Tolulope Joseph Ogunniyi, Sarah Sokolabe Yisa, Oluwaloseyi Ayomipo Olorunfemi, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7754583/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Health insurance, intended to reduce financial burdens and enhance affordability of healthcare services, remains a relatively new concept in Nigeria. Despite efforts to expand its coverage, approximately 90% of Nigerians lacked health insurance as of 2024. This study assessed the awareness, utilization, and the socioeconomic and healthcare factors influencing health insurance uptake in Ilorin, Kwara State. Method The study employed a cross-sectional design conducted among adults from the ages of 18 years and 70 years within Ilorin, Kwara State, Nigeria. Data was collected within the period of 3 months (July to September 2024) using semi-structured questionnaires covering the awareness, utilization and associated factor to health insurance uptake. Descriptive statistics, chi-square and logistic regression were conducted using SPSS version 25.0 whilst setting statistical significance with p-values at ≤ 0.05. Result Of the 415 participants, 243 (59.3%) were aware of health insurance, but only 121 (29.9%) are enrolled, with healthcare providers (37.4%) being the main source. The National Health Insurance Authority (NHIA) has the highest enrollment rate (51.2%). Among the insured, the most reported challenge was limited coverage for certain conditions (22.5%), while the uninsured mostly reported lack of awareness of available plans (33.3%). However, being a healthcare worker significantly increased awareness of health insurance (AOR = 2.368, 95% CI: 1.446–3.878, p = 0.001); single individuals showed (AOR = 0.366, 95% CI: 0.190–0.704, p = 0.003) lesser awareness. Additionally, those who were aware of health insurance were more likely to enroll (AOR = 13.893, 95% CI: 6.637–29.080, p = 0.000) and being a healthcare worker was not significantly linked to enrollment (AOR = 0.913, 95% CI: 0.538–1.549, p = 0.737). Conclusion Despite moderate awareness of health insurance, actual enrollment remained low, driven more by perceived healthcare access and system confidence than by knowledge or affordability. Limited coverage and low enrollment further hinder uptake. Targeted interventions addressing socio-economic and healthcare system barriers are essential to improve health insurance utilization and advance progress toward Universal Health Coverage (UHC). Health Insurance Awareness Health Coverage Out-of-Pocket Payment Kwara State Nigeria Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Every health system has recognized universal health coverage (UHC) as a top priority [ 1 ]. The World Health Organization (WHO) has repeatedly called on many countries to establish a prepaid healthcare financing systems facilitating access to high-quality healthcare and give family the necessary safeguard against the disastrous effects of healthcare-associated out-of-pocket (OOP) expenses, demonstrating the significance of the objective [ 1 ]. Prepayment mechanisms, including health insurance, are widely regarded as the most reliable approach to achieving universal health coverage [ 2 , 3 ]. However, prepayment systems are well-established in developed countries, but many developing countries, especially in Africa, still rely on out-of-pocket payments, which negatively affects people's health, hinders efforts to achieve universal health coverage, and continues to financially burden over 200 million people, including more than 150 million people in the WHO Africa Region [ 4 ]. Nigeria’s healthcare system is financed through multiple sources, including private sector contributions such as external donor backings, government-based public-driven funding, out-of-pocket payments, social health insurance, and community-based health funding [ 5 ]. However, Nigeria health insurance are covered as either the Social (National) Health Insurance and the Private Health Insurance. The establishment of National Health Insurance Authority (NHIA) under the National Health Insurance Scheme (NHIs) Act 35 of 1999, overarching goal is to ensure widespread access to cost-effective, high-quality healthcare services for insured individuals and their beneficiaries. The NHIS aims to prevent excessive medical expenses while regulating the rising cost of healthcare services in Nigeria. It ensures a steady flow of funds for the scheme’s efficient operation and promotes fairness in distributing healthcare costs across different income groups. Furthermore, the scheme seeks to encourage private sector involvement in healthcare service delivery, contributing to a more sustainable and inclusive healthcare system [ 6 – 8 ]. Following the establishment of health insurance, it still remains a new concept in Nigeria and several other African nations. Despite efforts to expand NHIS coverage, registering clients into the scheme remains suboptimal. As of 2024, fewer than 10% of Nigerians were enrolled, with most beneficiaries drawn primarily from a small segment of federal workers. Consequently, most of the population still lacks access to health insurance [ 9 ]. Even though fewer than 10% of Nigerians are engaged in the NHIS program at the moment, coverage varies by location [ 10 ]. Also, awareness of health insurance is particularly poor in the informal sector, where many individuals either lack knowledge of the scheme or do not fully understand its benefits. In contrast, awareness is higher among those in the formal sector, yet enrollment remains suboptimal despite a demonstrated willingness to participate. A major challenge affecting uptake is the voluntary nature of enrollment, especially for informal sector workers, who must actively subscribe and make annual premium payments making health insurance inaccessible to many, particularly the poor and vulnerable [ 11 ]. However, the Nigerian government authorized the establishment and operation of state-supported health insurance schemes (SSHIS) in 2015 in order to expand coverage of the informal and formal sectors. The NHIA provided financial and technical assistance for these schemes [ 10 , 12 ]. The goal of this decentralizing reform was to increase stakeholders' commitment to and sense of ownership over the health insurance system, which would help the states move closer to attaining universal health coverage [ 10 ]. Therefore, SSHIS plans have been implemented in roughly 20 states to varying degrees since its start [ 13 ]. Nevertheless, several factors contribute to the low uptake of health insurance, including weak legal frameworks, poor policy implementation, inadequate government funding, and a lack of political commitment to making health insurance mandatory for all citizens. The informal sector, which makes up a major portion of Nigeria’s workforce, struggles with financial constraints that make regular insurance contributions difficult. Moreover, inefficiencies within the NHIS’s regulatory and administrative structures discourage enrollment. Among women, especially those in the informal sector, the situation is even more concerning [ 11 ]. A study in Nigeria establish that majority (97.9%) of women of reproductive age were not captured by health insurance, highlighting a critical gap in healthcare access for this demographic group. Given that women play a central role in family health and well-being, their exclusion from health insurance coverage poses a serious public health challenge [ 14 ]. Healthcare delivery in Nigeria also faces broader issues, such as inadequate funding, low motivation among health workers, and unequal access to medical services. The government allocates only a small percentage of the national gross domestic product (GDP) to public healthcare, far below international recommendations. As a result, rural areas, where the majority of the population resides, often experience constricted access to healthcare, which is typically of lower quality than in urban centers [ 15 ]. A study conducted in Ilorin, Kwara State, revealed that awareness of the NHIS was significantly higher among workers within the formal sector compared to those in the informal sector, where knowledge of the scheme remains low. Awareness was notably greater among federal government employees, individuals with post-secondary education, and younger, single individuals, suggesting that educational level and employment type influence knowledge and utilization of health insurance [ 3 ]. The study also highlighted that awareness plays a crucial role in health insurance enrollment, as individuals with better knowledge about the scheme were more likely to participate. Despite this, coverage remains low, particularly among those in informal employment and non-working group, underscoring the need for targeted awareness campaigns [ 3 ]. This work sought to examine the awareness, and enrollment in health insurance among Ilorin residents, with a focus on identifying the key socioeconomic and healthcare factors that influence participation in the scheme. Methods Study Design and Setting We adopted a cross-sectional research approach carried out in Ilorin the capital of Kwara State, located in western Nigeria. Despite being in the North-Central geopolitical zone, Ilorin is classified as a Yoruba city on all historical and sociological grounds. According to the 2006 census, it has 777,667 inhabitants, making it the seventh-largest city in Nigeria [ 16 ]. The contemporary city serves as a hub for commerce, industry, and education. A nursing home for the aged and other public, private, and religious hospitals are also encompassed health services [ 17 ]. Sample size, Study population and Sampling The initial study population was calculated using a 50% assumed proportion at a 95% confidence interval, yielding a 384-sample size. After alteration with a 10% attrition rate, the sample size increased to 422 and was further expanded to 480 to allow quota allocation across worker categories in Ilorin, where occupational data are limited. Participants were recruited using a stratified probability sampling technique, with strata defined as non-working groups, formal/official sector workers, and informal sector workers to ensure adequate representation. A 3:2:1 ratio was applied, allocating 240 respondents to the non-working highest group, 160 to the formal/official sector, and 80 to the informal lowest sector. Inclusion and Exclusion Criteria Individuals between the ages of 18 and 70 who agreed to take part in the study were included. This study eliminated those who felt like they belonged to this age range but had not lived in Ilorin for more than a year, as well as people who had mental health issues and had trouble communicating. Data Collection This study employed a refined semi-structured questionnaire adapted from previous studies conducted in Nigeria [ 3 , 18 , 19 ], tailored to capture existing knowledge on preventive care access and health insurance utilization. The data collection team then collected the relevant information from the participants between the month of July-September 2024 Measurement and study variables The questionnaire covered comprehensive details about the demographic and socio-economic independent variables, health-related information on universal health coverage, healthcare access and financial constraint, awareness, and enrollment in health insurance (outcome/dependent variables) among people living in Ilorin, Kwara State. The demographic and socio-economic variables assessed were age, sex, religion, occupation, educational status, health-related information such as status of healthcare in Ilorin, awareness about UHC, financial hardship, confidence in accessing healthcare services in Ilorin (Supplementary file 1). Data storage/management To ensure confidentiality, the questionnaire data were stored in a password-protected folder accessible only by the research principal investigator. Prior to analysis, the data were checked for accuracy, consistency, and completeness, then entered into Excel and securely stored with restricted access. Data analysis​ The stored data was imported to SPSS version 26 for analysis. Descriptive statistics including frequency, percentage, and bar charts were used for presenting data on demographic and socio-economic variables, health-related variables, awareness, utilization of health insurance and barriers associated with health insurance. Inferential statistics such as chi-square was employed to check the connection between health-associated factors, awareness and utilization of health insurance among the study respondents. Additionally, univariate and multivariate logistic regression analysis was utilized to assess the association between independent variables and outcome variables (awareness and utilization of health insurance) and to establish the true predictors of the dependent factors using adjusted odd ratios. The significance of the inferential statistics was considered at ≤ 0.05 p-values. Ethical Approval The Kwara State Ministry of Health's Ethical Review Committee in Ilorin, was consulted and gave the study’s ethical approval under reference number ERC/MOH/2024/06/312. Prior to being recruited for the study, each participant had to provide their informed consent. To protect participant responses, their data was anonymized and kept private. Results Socio-demographic characteristics of the study participants A total of 415 participants completed the survey. The majority 236 (56.9%) were aged 18–27 years and female 218 (52.5%). Religion was nearly evenly distributed, with 210 (50.6%) identifying as Christian and 205 (49.4%) as Muslim. Most respondents were single 264 (63.6%), students 180 (43.4%), and had tertiary education 295 (71.1%). Additionally, 287 (69.2%) were non-healthcare workers, while 128 (30.8%) were healthcare workers. (Table 1). Table 1 : Demographics and socio-economic features of the participants sampled in Ilorin, 2024 (n=415) Variables Frequency Percent (%) Age Range 18-27 Years 236 56.9 28-37 Years 95 22.9 38-47 Years 47 11.3 48-57 Years 24 5.8 58-67 Years 9 2.2 68 and Above 4 1.0 Gender Male 197 47.5 Female 218 52.5 Religion Christianity 210 50.6 Islam 205 49.4 Marital Status Single 264 63.6 Married 142 34.2 Widowed 6 1.4 Divorced 3 0.7 Occupation Government Worker 88 21.2 Private Worker 51 12.3 Self Employed 69 16.6 Unemployed 22 5.3 Student 180 43.4 Retired 5 1.2 Educational Level Primary School 6 1.4 Secondary School 26 6.3 Tertiary 295 71.1 Postgraduate 86 20.7 No Formal Education 2 0.5 Healthcare Worker Yes 128 30.8 No 287 69.2 Participants General Health Information Awareness The largest proportion of 182 (43.9%) participants in the study rated healthcare in Ilorin as Good. Regarding knowledge of Universal Health Coverage (UHC), 259 (62.4%) reported being informed about it, while 388 (93.5%) agreed that healthcare access is a fundamental human right. 239 (57.6%) of the participants reported they did not experience financial hardship in accessing healthcare. Additionally, 151 (30.4%) were somewhat confident in accessing healthcare services (Table 2). Table 2: Distribution of participant’s health-related information in Ilorin, 2024 (n=415) Variables Frequency Percent (%) Perception Of Quality of Healthcare Services in Ilorin Excellent 38 9.2 Good 182 43.9 Fair 162 39.0 Poor 33 8.0 How well are you Informed with UHC Well Informed 77 18.6 Informed 259 62.4 Not Informed 79 19.0 Is access to healthcare a Fundamental Right? Yes 388 93.5 No 13 3.1 Undecided 14 3.4 You Experience Financial Hardship Accessing Healthcare? Yes 176 42.4 No 239 57.6 Confidence in Accessing Healthcare Service Very Confident 104 25.1 Somewhat Confidence 151 36.4 Not Very Confident 126 30.4 Not At All Confident 34 8.2 Information on the Enrollment and Utilization of Health Insurance Among Insured participants NHIS was the most utilized health insurance program, with 62 (51.2%) participants enrolled. The most commonly used healthcare service was doctor visits, reported by 64 (37.0%) of the participants. Healthcare access was mostly occasional, as indicated by 59 (48.8%) participants, while only 36 (29.8%) were satisfied with their access (Table 3). Table 3: Information on the utilization of Health Insurance among insured participants (n=121) Variables Frequency Percent (%) Health Insurance Enrolled in NHIS 62 51.2 Kwara Care 33 27.3 Private Health Insurance 26 21.5 Health Insurance Utilization Doctor’s Visit 64 37.0 Hospital Stays/Admission 34 19.7 Prescription Medication 43 24.9 Preventive Care 32 18.5 Health Insurance Usage Rate Regularly 27 22.3 Occasionally 59 48.8 Hardly ever 35 28.9 Satisfactory Level Very Satisfied 36 29.8 Somewhat Satisfied 43 35.5 Neutral 37 30.6 Somewhat dissatisfied 1 0.8 Very Dissatisfied 4 3.3 Awareness, and Enrollment in Health Insurance, and Perceptions of UHC Among Participants A total of 246 (59.3%) of participants were aware of health insurance, but only 121 (29.2%) are enrolled, leaving 294 (70.8%) unenrolled (Figure 1). Regarding UHC objectives, 40.5% prioritized quality healthcare, 36.3% emphasized health equity, and 23.3% focused on financial risk protection (Figure 2). The main sources of health insurance information were healthcare providers (37.4%), family and friends (24.4%), and social media (19.5%) (Figure 3). Health Insurance Utilization Barriers Among Insured and Enrollment Barriers Among Uninsured Participants Based on identified health insurance utilization barriers among insured and enrollment barriers among uninsured participants, the major challenge among the insured were limited coverage for certain conditions (22.5%), distance to healthcare facilities accounted for 16.4%, cost (12.7%) and long wait times was (12.7%). Other barriers were healthcare worker behavior (12.7%), difficulty in enrollment and renewal (9.9%), lack of transparency (7.0%), and limited access to healthcare (6.1%) (Figure 4a). For the uninsured, barriers included lack of awareness of available plans (33.3%), difficulty in enrollment (23.7%), cost (21.7%), lack of transparency and cost concerns (15.1%), and cultural or religious beliefs (6.2%) (Figure 4b). Healthcare-Related Factors Associated with Health Insurance Awareness and enrollment among Ilorin Respondents. This study examined how healthcare-related factors influence awareness and enrollment in health insurance amongst 415 participants in Ilorin. Awareness was generally higher among those who rated healthcare as excellent (63.2%) or good (64.3%), though the association was not significant (p = 0.084). A significant association was observed between awareness and knowledge of Universal Health Coverage (UHC) (p = 0.000); 64.9% of well-informed and 64.1% of moderately informed participants were aware of health insurance, compared to only 38.0% for the uninformed. Confidence in healthcare access was also significantly linked to awareness (p = 0.001), with the highest awareness (74.0%) among those very confident in accessing care. In contrast, health insurance enrollment was significantly associated with healthcare rating (p = 0.049) and confidence in access (p = 0.000). Enrollment was highest (50.0%) among participants who were very confident in accessing quality healthcare services, and lowest (18.3%) among those with little confidence. No significant associations were found between enrollment and UHC knowledge, financial hardship, or viewing healthcare as a right. Generally, confidence in healthcare access showed significant association with both awareness and enrollment, while UHC knowledge notably influenced awareness (Table 4). Table 4: Healthcare-Related factors associated with health insurance awareness and enrollment among respondents in Ilorin, 2024. (n=415) Variables Awareness Enrollment Yes No p-value Yes No p-value Rating of Healthcare in Ilorin Excellent 24(63.2) 14(36.8) 14(36.8) 24(63.2) Good 117(64.3) 65(35.7) 63(34.6) 119(65.4) Fair 91(56.2) 71(43.8) 0.084 37(22.8) 125(77.2) 0.049* Poor 14(42.4) 19(57.6) 7(21.2) 26(78.8) Knowledge About UHC Well Informed 50(64.9) 27(35.1) 23(29.9) 54(70.1) Informed 166(64.1) 93(35.9) 0.000* 82(31.7) 177(68.3) 0.147 Not Informed 30(38.0) 49(62.0) 16(20.3) 63(79.7) Is access to healthcare a Fundamental Right? Yes 232(59.8) 156(40.2) 115(29.6) 273(70.4) No 7(53.8) 6(46.2) 0.704 4(30.8) 9(69.2) 0.459 Undecided 7(50.0) 7(50.0) 2(14.3) 12(85.7) You have Financial Hardship accessing healthcare services? Yes 104(59.1) 72(40.9) 0.947 49(27.8) 127(72.2) 0.613 No 142(59.4) 97(40.6) 72(30.1) 167(69.9) Confidence in Healthcare Access Very Confident 77(74.0) 27(26.0) 52(50.0) 52(50.0) Somewhat Confident 90(59.6) 61(40.4) 0.001* 38(25.2) 113(74.8) 0.000* Not Very Confident 61(48.4) 65(51.6) 23(18.3) 103(81.7) Not At All Confident 18(52.9) 16(47.1) 8(23.5) 26(76.5) * = Significant p-value (≤ 0.05) Health Insurance Program Access and Satisfaction Among Study Respondents The association between health insurance program access and satisfaction revealed a significant relationship (P ≤ 0.05). Among NHIA users, 25(40.3%) were somewhat satisfied, while 13(39.4%) of Kwara Care users were very satisfied. In addition, 10(38.5%) of those with private health insurance were neutral toward their program (Table 5). Table 5: Association between health insurance program access and level of satisfaction among insured participants sampled in Ilorin, 2024 (n=121) Variables Very satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied p-value NHIA 17(27.4) 25(40.3) 17(27.4) 0(0.0) 3(4.8) Kwara Care 13(39.4) 9(27.3) 10(30.3) 1(3.0) 0(0.0) 0.000* Private Health Insurance Agency 6(23.1) 9(34.6) 10(38.5) 0(0.0) 1(3.8) Total 36 (29.75%) 43(35.54%) 37 (30.58%) 1 (0.83%) 4 (3.31%) Predictor of Health Insurance Awareness Among the Study Respondents The univariate logistic regression analysis from this study shows that marital status is a significant predictor of the awareness of health Insurance with Single individuals (adjusted OR = 0.416, 95% CI: 0.270-0.639, p = 0.000) having lesser chances of been aware of health insurance than those previously or presently married. Age-group was also a significant predictor of health insurance awareness with 18-27 years age-bracket presenting AOR = 0.613, 95% CI: 0.410-0.915, p = 0.017 and having lesser chance of been aware than those within 28 years and above. However, Formal sector members (AOR = 2.338, 95% CI: 1.469-3.723, p = 0.000) were more likely to be aware of health insurance than those working in informal sector and non-working group. Similarly, Healthcare workers (AOR = 2.740, 95% CI: 1.726-4.350, p = 0.000) were more likely to be awareness of health insurance as compared to those who are not healthcare workers. Education, gender and religion did not present as significant predictors of health insurance awareness (Table 6). In the Multivariate analysis, being an healthcare worker still remains a strong predictor of being aware of health insurance (AOR = 2.368, 95% CI: 1.446–3.878, p = 0.001) compared to being a non-healthcare worker. Marital status was also a significant predictor, with single individuals (AOR = 0.366, 95% CI: 0.190–0.704, p = 0.003) showing lesser chance of awareness than those married or previously married. Gender and religion, particularly Christianity (AOR = 0.915, 95% CI: 0.601–1.392, p = 0.678) showed no significant association. Other factors such as Educational level and occupation were similarly also non-significant (Table 6). Table 6. Influence of Socio-demographics on Awareness of health insurance among study Resampled in Ilorin, 2024 (n=415) Variable Univariate Multivariate Crude OR (CI) p-value Adjusted OR (CI) p-value Gender Male 1.284(0.866-1.903) 0.213 1.248(0.811-1.919) 0.314 Female Reference Age 18-27 0.613(0.410-0.915) 0.017* 1.032(0.563-1.891) 0.920 28 and above Reference Marital status Single 0.416(0.270-0.639) 0.000* 0.366(0.190-0.704) 0.003* Married/Formerly (Divorced/Widowed) Reference Religion Christian 0.836(0.565-1.237) 0.371 0.915(0.601-1.392) 0.678 Islam Reference Education Basic/No formal 0.216(0.043-1.087) 0.063 0.273(0.050-1.481) 0.132 Secondary 0.649(0.293-1.439) 0.288 0.841(0.367-1.929) 0.683 Higher Institution Reference Occupation Formal Sector 2.338(1.469-3.723) 0.000* 1.081(0.584-1.999) 0.805 Informal Sector 0.734(0.425-1.267) 0.266 0.541(0.279-1.052) 0.070 Non-Working Group Reference Healthcareworker Yes 2.740(1.726-4.350) 0.000* 2.368(1.446-3.878) 0.001* No Reference * = Significant p-value ≤ 0.05; OR= Odd ratios Predictors of Health Insurance Utilization Among the Study Participants In the Univariate analysis, age was a significant predictor of the enrollment in health insurance with age group 18-27 (aOR = 0.415, 95% CI: 0.293-0.693, p = 0.000) being less likely to enroll in health insurance than individuals who are 28 years and above. Also, individuals who are single (aOR = 0.434, 95% CI: 0.281-0.670, p = 0.000) less likely to enroll in health insurance than individuals that are ever married. More so, Individuals working in formal sector (aOR = 2.655, 95% CI: 1.657-4.254, p = 0.000) more likely of health insurance enrollment than those in informal sector or non-working group. Additionally, Healthcare workers were more likely to enroll in health insurance (aOR =1.586, 95% CI: 1.014-2.479, p = 0.043). ,Also, health insurance awareness is a strong predictor of health insurance enrollment (aOR = 14.859, 95% CI: 7.256-30.429, p = 0.000). However, Education, gender and religion are not a significant predictor of health insurance utilization (Table 7). In multivariate analysis, enrollment in health insurance was significantly associated with awareness, with those aware more likely to enroll (aOR = 13.893, 95% CI: 6.637–29.080, p = 0.000). Surprisingly, after adjusting for cofounders, occupation, age group, marital status are significant predictors in the univariate analysis, became non-significant predictor of health insurance utilization. Also, gender, religion and been a healthcare worker does not stand as a significant predictor of health insurance utilization (Table 7). Table 7. Influence of respondents’ socio-demographics on enrollment of health insurance (n=415) Variable Univariate Multivariate Crude OR (CI) p-value Adjusted OR (CI) p-value Gender Male 1.493(0.976-2.285) 0.065 1.225(0.744-2.015) 0.425 Female Reference Age 18-27 0.415(0.293-0.693) 0.000* 0.583(0.295-1.155) 0.122 28 and above Reference Marital status Single 0.434(0.281-0.670) 0.000* 1.062(0.507-2.225) 0.872 Married/formerly Married (Divorced/Widowed) Reference Religion Christian 0.860(0.563-1.314) 0.486 0.895(0.549-1.458) 0.655 Islam Reference Education Basic/No formal 0.343(0.042-2.821) 0.320 0.616(0.053-7.175) 0.699 Secondary 1.067(0.451-2.526) 0.882 1.884(0.672-5.279) 0.228 Higher Institution Reference \ Occupation Formal Sector 2.655(1.657-4.254) 0.000* 1.696(0.847-3.397) 0.136 Informal Sector 1.177(0.621-2.231) 0.618 1.144(0.503-2.601) 0.749 Non-Working Group Reference Healthcare worker Yes 1.586(1.014-2.479) 0.043* 0.913(0.538-1.549) 0.737 No Reference Awareness Yes 14.859(7.256-30.429) 0.000* 13.893(6.637-29.080) 0.000* No Reference * = Significant p-value ≤ 0.05; OR= Odd ratio Discussion The combined findings from this research provide a comprehensive and nuanced understanding of health insurance awareness and enrollment among residents of Ilorin, Nigeria, and highlight both progress and persistent challenges on the path toward universal health coverage (UHC). A central finding of this study revealed 59.3% of participants reported being aware of health insurance, yet only 29.9% actually enrolled in it, leaving a significant 70.8% of the surveyed population uninsured. This is akin to some studies in Nigeria that reported low enrollment rates between 0.3% and 13.5% [3,20-22]. However, Effiong et al. [10] reported an increase in health insurance enrollee in Kwara State of about 37.3% which focus only on Kwara care enrollment as compared this study assessing both NHIS, Kwara care and private health insurance. Although a study conducted among federal civil servant in Rivers State reported higher enrollment rate of 83.8% [23]. These findings reflect the regional variation in health insurance uptake, and low acceptance and reluctance to pay premiums, especially in the informal sector, which harbors over 70% of Nigeria's workers and non-working group [24]. However, our work reported a low coverage rate possibly because it was conducted among people working in formal sector, informal and those who are in non-working groups. This could imply that the health insurance has difficulties breaking into the unorganized sector. Additionally, although making up half of all respondents, students (non-working group) and younger adults were primarily uninsured in the majority of our study states, indicating unique obstacles to young adults' coverage under the program [10]. The gap between awareness and enrollment is not only peculiar to Ilorin, but it mirrors national trends across many Nigerian states, where fewer than 10% of the populace are enrolled in the NHIS despite its introduction over two decades ago [3]. The relatively high awareness rate in Ilorin may be attributed to its urban setting and the predominance of young, educated participants who had tertiary education and also an effect of the previous community based health insurance in kwara state that’s has been running in 2006 and the subsequent state health insurance which runs in 2018 has contributed to raising significant level of awareness about health insurance with community mobilization and engagement tactics [3,7, 25]. Previous research has consistently shown that higher education levels and formal employment are associated with greater awareness and uptake of health insurance [3]. In this study, of the 29.2% enrollment rate, NHIA (51.2%) was the most accessed insurance package. Despite this relatively high awareness, actual enrollment in health insurance remains low, especially among informal sector workers and non-working groups, as buttressed by similar studies conducted in Nigeria which reported enrollment rate between 6.7 and 21.1% [13,26] and a study conducted by Mwinuka et al. [27] among informal sector in Tazania reporting enrollment rate of 9.1%. The voluntary nature of health insurance enrollment in Nigeria, particularly for those in the informal sector, continues to be a significant barrier. Many informal workers lack stable incomes, making regular premium payments difficult [7,26]. This study and several other study also reported that cost and difficulty in enrollment were among the most frequently cited barriers for the uninsured, alongside lack of awareness of available plans [7,26]. These challenges are compounded by weak legal frameworks, inadequate government funding, and inefficiencies in the scheme’s administration, as noted in broader literature [13,26]. In this study, awareness and utilization were significantly higher among formal sector workers, individuals with tertiary education, younger and single individuals. This is in line with findings from Adewole et al. [3], who reported that education and employment type are strong predictors of health insurance awareness and utilization. The barriers to health insurance utilization observed in this work are multifaceted affecting both the insured and uninsured. This study reported lack of awareness of available plans, difficulty in enrollment, and cost as the major barrier to enrollment of health insurance among uninsured participants. However, those who are insured expressed dissatisfaction which stemmed from limited coverage for certain conditions, distance to healthcare facilities, cost, long waiting times, negative healthcare worker behavior, and difficulty with enrollment and renewal. These findings are consistent with previous research showing that administrative complexity, limited benefit packages, and negative experiences with healthcare providers can discourage both enrollment and continued participation [3,7,26,28]. Additionally, the study highlights other factors such as low level of trust in government social policies, poverty, and lack of trust in managing health insurance scheme funds, while disagreements from cultural and pious beliefs are also frequent barriers in Nigeria and other similar settings [28-30]. The complexity of the enrollment process and the lack of tailored information for informal sector workers further exacerbate these challenges [31] Surprisingly, this study reported that, only 29.8% of insured participants expressed satisfaction with their healthcare access, though most of them (35.5%) were just partially satisfied with their insurance services. A large proportion reported only occasional access to healthcare services. This suggests that even for those who are insured, the perceived value and quality of insurance programs may be limited, potentially undermining trust and willingness to recommend or renew coverage [3,7]. The limited coverage for certain conditions and the distance to healthcare facilities were notable sources of dissatisfaction among the insured [3,7]. This study found financial hardship not to be significantly associated with either awareness or utilization of health insurance. Enrollment rates were similar among those experiencing financial hardship and those who were not. However, confidence in healthcare access was significantly associated with both awareness and enrollment compared to much lower rates among those with low or no confidence. This finding aligns with broader evidence that trust in health systems is a critical driver of insurance [32]. Healthcare providers were the main source of information about health insurance, followed by family/friends and social media. This highlights the influential role of trusted intermediaries and the potential for leveraging these channels in future awareness and enrollment campaigns. The role of healthcare providers as the primary source of information suggests that interventions aimed at increasing awareness and uptake can benefit by involving healthcare workers as advocates and educators [3,7]. Also, all insured participants reported satisfaction to the program they were enrolled in with just few being dissatisfied, reflecting feelings of adequacy in the services they were getting from the program. In this study, the major access to information about health insurance was reported to be from healthcare workers which makes an healthcare provider to be more aware of health insurance awareness. Although awareness and information access by healthcare workers related to health insurance, does not translate to its enrollment. This could probably be attributed to perceived feelings of self confidence in catering for their health services when they needed it. Also, the study highlighted that awareness plays a crucial role in health insurance enrollment, as individuals with better knowledge about the scheme were more likely to participate. This suggests that to improve the enrollment rate, the state needs to strengthen the awareness level and community engagement in every sector, most especially the informal sector and non-working group. Policy Implications and Recommendations In summary, while awareness of health insurance in Ilorin is higher than national averages, enrollment remains low due to a complex interplay of socioeconomic, structural, and perceptual barriers. Addressing these challenges will require multifaceted interventions, including: Targeted Awareness Campaigns: Leveraging healthcare providers, social media, and community leaders to disseminate information, especially to less-educated and informal sector populations. Simplification of Enrollment Processes: Reducing administrative complexity and making enrollment more accessible for informal workers and vulnerable groups. Expansion of Coverage Options: Broadening the benefit packages to cover more conditions and services and ensuring that coverage meets the needs of diverse populations. Building Trust and Satisfaction: Improving the quality of healthcare services, addressing negative provider behaviors, and ensuring transparency in fund management to foster trust in the health insurance system. Innovative Communication Strategies: Developing culturally appropriate, easy-to-understand educational materials and community-based outreach programs, as demonstrated by successful models in other Nigerian states. Strengths of the Study The strength of this study lies the findings generated from this study which is unveils gaps in awareness and enrollment in health insurance and the barriers associated with enrollment and utilization of health insurance which is relevants to achieving UHC goals in Nigeria. Limitations of the Study The limitations of this study lies on the cross-sectional study design used, which limits the ability to observe changes in awareness or enrollment over time or to track the impact of interventions. Also, the absence of qualitative data (e.g., focus group discussions, in-depth interviews) might limit a deeper understanding of the "why" behind some of the observed behaviors and perceptions, particularly concerning trust, cultural beliefs, or specific administrative frustrations. Conclusion This study on health insurance in Ilorin, Nigeria, reveals a significant gap between awareness and enrollment. While most residents are aware of health insurance, only few individuals are enrolled, leaving majority uninsured. This trend mirrors national challenges, particularly affecting informal sector workers and vulnerable groups. Despite progress in awareness, significant effort is needed to boost health insurance enrollment and effective utilization in Ilorin. This requires targeted interventions, policy reforms, and increased stakeholder engagement to make health insurance accessible, affordable, and trustworthy for everyone. Declarations Acknowledgement We acknowledged the Kwara State ministry of health ethical review committee for their contributions and kind support towards the project. We also acknowledged the support of Ogunniyi Oluwanifemi, Abdulhameed Rodiat, Arinde Wisdom Emmanuel, Olaleye David, Alawonla Yetunde Arinola, Lolade Albarika, Akingbade Esther Adeola in the collection and collation of the data. Ethical Approval The Kwara State Ministry of Health’s ethical review committee based in Ilorin gave the ethical approval with reference number: ERC/MOH/2024/06/312 for the study. The research was carried out in accordance with the Helsinki declaration act. Consent to Participate All participants gave their consents to participate in the research work. Consent for Publication Not Applicable Conflict of Interest Authors declare no conflict of Interest Source of Funding There was no external source of funding for this research work Data Availability All data generated are embedded in this manuscript Authors Contribution TJO: Conceptualized the study idea, took part in data collection, data analysis, writing the study’s first draft, proofreading and editing of the manuscript. SSY & OAO: Conceptualization of the study, data collection, and writing of the manuscript. MOA & OPO: Conceptualization of the study, design of data collection materials, data collection and writing of the second Manuscript. MZP: Review, Proofreading and editing of the final manuscript. ARE: Writing of the Manuscript. RDD: Headed the study discussion, Supervision, Proofreading and editing of the manuscript. FBE: Supervised, review, Proofreading and editing of the manuscript. References Abiiro GA, De Allegri M. 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International Quarterly of Community Health Education. 2016;(4):241-246. doi:10.1177/0272684x16657451 Bolarinwa OA, Akande TM, Janssens W, Boahene K, de Wit TR. Effects of a temporary suspension of community-based health insurance in Kwara State, North-Central, Nigeria. Pan African Medical Journal. Published online 2022. doi:10.11604/pamj.2022.41.10.27978 Adewole DA, Akanbi SA, Osungbade KO, Bello S. Expanding health insurance scheme in the informal sector in Nigeria: awareness as a potential demand-side tool. Pan African Medical Journal. Published online 2017. doi:10.11604/pamj.2017.27.52.11092 Mwinuka B, Echoka E, Nyaberi J. Accessibility of Health Insurance among Informal Sector Workers in Dar es Salaam Tanzania: What Are the Barriers? Open Journal of Social Sciences. 2023;(06):44-59. doi:10.4236/jss.2023.116004 Adewole DA, Adebayo AM, Udeh EI, Shaahu VN, Dairo MD. Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria. The American Society of Tropical Medicine and Hygiene. 2015;(3):648-654. doi:10.4269/ajtmh.14-0245 Onyemaechi SB, Ezenwaka UR. Leveraging Innovative Financing Strategy to Increase Coverage and Resources Among Informal Sector for Social Health Insurance Within the Nigerian Context of Devolution: Evidence From Adoption Model Implementation. Frontiers in Public Health. Published online July 14, 2022. doi:10.3389/fpubh.2022.894330 Obasi O, Ezeh C. Analysis of Social Health Insurance in Nigeria and Its Challenges . International Journal of Public Administration. 2024;(3(2)):420-437. Onasanya AA. Increasing health insurance enrolment in the informal economic sector. Journal of Global Health. 2020;(1). doi:10.7189/jogh.10.010329 Onwujekwe OE, Uzochukwu BS, Obikeze EN, et al. Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria. BMC Health Services Research. 2010;(1). doi:10.1186/1472-6963-10-67 Additional Declarations No competing interests reported. Supplementary Files HealthInsuranceSupplementaryFile.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7754583","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542183575,"identity":"ef0db1c2-e602-4057-86fd-50b6023666f9","order_by":0,"name":"Tolulope Joseph 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(n=246)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7754583/v1/67fbf7b3de8d78a679485d2a.jpg"},{"id":95528964,"identity":"5e44a5eb-fcd5-4d8c-a8c0-dafbc04cd9dc","added_by":"auto","created_at":"2025-11-10 10:16:38","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":67113,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4a:\u003c/strong\u003e \u003cem\u003ePerceived Barriers of health insurance utilization among participants under health insurance (n=121)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7754583/v1/c60bb0a9b600f6186fd916f3.jpg"},{"id":95528984,"identity":"acad9be4-fb9e-4f74-a830-5f64ffa98bfb","added_by":"auto","created_at":"2025-11-10 10:16:40","extension":"jpg","order_by":5,"title":"Figure 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09:28:10","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":15071,"visible":true,"origin":"","legend":"","description":"","filename":"HealthInsuranceSupplementaryFile.docx","url":"https://assets-eu.researchsquare.com/files/rs-7754583/v1/0e76233298ba8533323cc48e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Socio-economic and Healthcare Determinants of Health Insurance Awareness and Enrollment in Ilorin, Nigeria","fulltext":[{"header":"Background","content":"\u003cp\u003eEvery health system has recognized universal health coverage (UHC) as a top priority [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The World Health Organization (WHO) has repeatedly called on many countries to establish a prepaid healthcare financing systems facilitating access to high-quality healthcare and give family the necessary safeguard against the disastrous effects of healthcare-associated out-of-pocket (OOP) expenses, demonstrating the significance of the objective [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrepayment mechanisms, including health insurance, are widely regarded as the most reliable approach to achieving universal health coverage [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, prepayment systems are well-established in developed countries, but many developing countries, especially in Africa, still rely on out-of-pocket payments, which negatively affects people's health, hinders efforts to achieve universal health coverage, and continues to financially burden over 200\u0026nbsp;million people, including more than 150\u0026nbsp;million people in the WHO Africa Region [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNigeria\u0026rsquo;s healthcare system is financed through multiple sources, including private sector contributions such as external donor backings, government-based public-driven funding, out-of-pocket payments, social health insurance, and community-based health funding [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, Nigeria health insurance are covered as either the Social (National) Health Insurance and the Private Health Insurance. The establishment of National Health Insurance Authority (NHIA) under the National Health Insurance Scheme (NHIs) Act 35 of 1999, overarching goal is to ensure widespread access to cost-effective, high-quality healthcare services for insured individuals and their beneficiaries. The NHIS aims to prevent excessive medical expenses while regulating the rising cost of healthcare services in Nigeria. It ensures a steady flow of funds for the scheme\u0026rsquo;s efficient operation and promotes fairness in distributing healthcare costs across different income groups. Furthermore, the scheme seeks to encourage private sector involvement in healthcare service delivery, contributing to a more sustainable and inclusive healthcare system [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFollowing the establishment of health insurance, it still remains a new concept in Nigeria and several other African nations. Despite efforts to expand NHIS coverage, registering clients into the scheme remains suboptimal. As of 2024, fewer than 10% of Nigerians were enrolled, with most beneficiaries drawn primarily from a small segment of federal workers. Consequently, most of the population still lacks access to health insurance [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Even though fewer than 10% of Nigerians are engaged in the NHIS program at the moment, coverage varies by location [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Also, awareness of health insurance is particularly poor in the informal sector, where many individuals either lack knowledge of the scheme or do not fully understand its benefits. In contrast, awareness is higher among those in the formal sector, yet enrollment remains suboptimal despite a demonstrated willingness to participate. A major challenge affecting uptake is the voluntary nature of enrollment, especially for informal sector workers, who must actively subscribe and make annual premium payments making health insurance inaccessible to many, particularly the poor and vulnerable [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, the Nigerian government authorized the establishment and operation of state-supported health insurance schemes (SSHIS) in 2015 in order to expand coverage of the informal and formal sectors. The NHIA provided financial and technical assistance for these schemes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The goal of this decentralizing reform was to increase stakeholders' commitment to and sense of ownership over the health insurance system, which would help the states move closer to attaining universal health coverage [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, SSHIS plans have been implemented in roughly 20 states to varying degrees since its start [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNevertheless, several factors contribute to the low uptake of health insurance, including weak legal frameworks, poor policy implementation, inadequate government funding, and a lack of political commitment to making health insurance mandatory for all citizens. The informal sector, which makes up a major portion of Nigeria\u0026rsquo;s workforce, struggles with financial constraints that make regular insurance contributions difficult. Moreover, inefficiencies within the NHIS\u0026rsquo;s regulatory and administrative structures discourage enrollment. Among women, especially those in the informal sector, the situation is even more concerning [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A study in Nigeria establish that majority (97.9%) of women of reproductive age were not captured by health insurance, highlighting a critical gap in healthcare access for this demographic group. Given that women play a central role in family health and well-being, their exclusion from health insurance coverage poses a serious public health challenge [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Healthcare delivery in Nigeria also faces broader issues, such as inadequate funding, low motivation among health workers, and unequal access to medical services. The government allocates only a small percentage of the national gross domestic product (GDP) to public healthcare, far below international recommendations. As a result, rural areas, where the majority of the population resides, often experience constricted access to healthcare, which is typically of lower quality than in urban centers [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA study conducted in Ilorin, Kwara State, revealed that awareness of the NHIS was significantly higher among workers within the formal sector compared to those in the informal sector, where knowledge of the scheme remains low. Awareness was notably greater among federal government employees, individuals with post-secondary education, and younger, single individuals, suggesting that educational level and employment type influence knowledge and utilization of health insurance [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The study also highlighted that awareness plays a crucial role in health insurance enrollment, as individuals with better knowledge about the scheme were more likely to participate. Despite this, coverage remains low, particularly among those in informal employment and non-working group, underscoring the need for targeted awareness campaigns [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This work sought to examine the awareness, and enrollment in health insurance among Ilorin residents, with a focus on identifying the key socioeconomic and healthcare factors that influence participation in the scheme.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eWe adopted a cross-sectional research approach carried out in Ilorin the capital of Kwara State, located in western Nigeria. Despite being in the North-Central geopolitical zone, Ilorin is classified as a Yoruba city on all historical and sociological grounds. According to the 2006 census, it has 777,667 inhabitants, making it the seventh-largest city in Nigeria [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The contemporary city serves as a hub for commerce, industry, and education. A nursing home for the aged and other public, private, and religious hospitals are also encompassed health services [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSample size, Study population and Sampling\u003c/h3\u003e\n\u003cp\u003eThe initial study population was calculated using a 50% assumed proportion at a 95% confidence interval, yielding a 384-sample size. After alteration with a 10% attrition rate, the sample size increased to 422 and was further expanded to 480 to allow quota allocation across worker categories in Ilorin, where occupational data are limited. Participants were recruited using a stratified probability sampling technique, with strata defined as non-working groups, formal/official sector workers, and informal sector workers to ensure adequate representation. A 3:2:1 ratio was applied, allocating 240 respondents to the non-working highest group, 160 to the formal/official sector, and 80 to the informal lowest sector.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eIndividuals between the ages of 18 and 70 who agreed to take part in the study were included. This study eliminated those who felt like they belonged to this age range but had not lived in Ilorin for more than a year, as well as people who had mental health issues and had trouble communicating.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eThis study employed a refined semi-structured questionnaire adapted from previous studies conducted in Nigeria [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], tailored to capture existing knowledge on preventive care access and health insurance utilization. The data collection team then collected the relevant information from the participants between the month of July-September 2024\u003c/p\u003e\n\u003ch3\u003eMeasurement and study variables\u003c/h3\u003e\n\u003cp\u003eThe questionnaire covered comprehensive details about the demographic and socio-economic independent variables, health-related information on universal health coverage, healthcare access and financial constraint, awareness, and enrollment in health insurance (outcome/dependent variables) among people living in Ilorin, Kwara State. The demographic and socio-economic variables assessed were age, sex, religion, occupation, educational status, health-related information such as status of healthcare in Ilorin, awareness about UHC, financial hardship, confidence in accessing healthcare services in Ilorin (Supplementary file 1).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData storage/management\u003c/h2\u003e\u003cp\u003eTo ensure confidentiality, the questionnaire data were stored in a password-protected folder accessible only by the research principal investigator. Prior to analysis, the data were checked for accuracy, consistency, and completeness, then entered into Excel and securely stored with restricted access.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData analysis​\u003c/h3\u003e\n\u003cp\u003eThe stored data was imported to SPSS version 26 for analysis. Descriptive statistics including frequency, percentage, and bar charts were used for presenting data on demographic and socio-economic variables, health-related variables, awareness, utilization of health insurance and barriers associated with health insurance. Inferential statistics such as chi-square was employed to check the connection between health-associated factors, awareness and utilization of health insurance among the study respondents. Additionally, univariate and multivariate logistic regression analysis was utilized to assess the association between independent variables and outcome variables (awareness and utilization of health insurance) and to establish the true predictors of the dependent factors using adjusted odd ratios. The significance of the inferential statistics was considered at \u0026le;\u0026thinsp;0.05 p-values.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Kwara State Ministry of Health\u0026apos;s Ethical Review Committee in Ilorin, was consulted and gave the study\u0026rsquo;s ethical approval under reference number ERC/MOH/2024/06/312. Prior to being recruited for the study, each participant had to provide their informed consent. To protect participant responses, their data was anonymized and kept private.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics of the study participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 415 participants completed the survey. The majority 236 (56.9%) were aged 18\u0026ndash;27 years and female 218 (52.5%). Religion was nearly evenly distributed, with 210 (50.6%) identifying as Christian and 205 (49.4%) as Muslim. Most respondents were single 264 (63.6%), students 180 (43.4%), and had tertiary education 295 (71.1%). Additionally, 287 (69.2%) were non-healthcare workers, while 128 (30.8%) were healthcare workers. (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e: \u003cem\u003eDemographics and socio-economic features of the participants sampled in Ilorin, 2024 (n=415)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAge Range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e18-27 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e56.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28-37 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38-47 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48-57 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58-67 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68 and Above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eChristianity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGovernment Worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrivate Worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSelf Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrimary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSecondary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo Formal Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare Worker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e69.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants General Health Information Awareness\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe largest proportion of 182 (43.9%) participants in the study rated healthcare in Ilorin as Good. Regarding knowledge of Universal Health Coverage (UHC), 259 (62.4%) reported being informed about it, while 388 (93.5%) agreed that healthcare access is a fundamental human right. 239 (57.6%) of the participants reported they did not experience financial hardship in accessing healthcare. Additionally, 151 (30.4%) were somewhat confident in accessing healthcare services (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e \u003cem\u003eDistribution of participant\u0026rsquo;s health-related information in Ilorin, 2024 (n=415)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerception Of Quality of Healthcare Services in Ilorin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eExcellent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e43.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow well are you Informed with UHC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eWell Informed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eInformed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e62.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eNot Informed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 445px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIs access to healthcare a Fundamental Right?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e93.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 445px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYou Experience Financial Hardship Accessing Healthcare?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e57.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 445px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConfidence in Accessing Healthcare Service\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eVery Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e25.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eSomewhat Confidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e36.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eNot Very Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eNot At All Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eInformation on the Enrollment and Utilization of Health Insurance Among Insured participants\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNHIS was the most utilized health insurance program, with 62 (51.2%) participants enrolled. The most commonly used healthcare service was doctor visits, reported by 64 (37.0%) of the participants. Healthcare access was mostly occasional, as indicated by 59 (48.8%) participants, while only 36 (29.8%) were satisfied with their access (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e \u003cem\u003eInformation on the utilization of Health Insurance among insured participants (n=121)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth Insurance Enrolled in\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eNHIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e51.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKwara Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrivate Health Insurance\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth Insurance Utilization\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDoctor\u0026rsquo;s Visit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHospital Stays/Admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrescription Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePreventive Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth Insurance Usage Rate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRegularly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHardly ever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSatisfactory Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVery Satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSomewhat Satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSomewhat dissatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVery Dissatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAwareness, and Enrollment in Health Insurance, and Perceptions of UHC Among Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 246 (59.3%) of participants were aware of health insurance, but only 121 (29.2%) are enrolled, leaving 294 (70.8%) unenrolled (Figure 1). Regarding UHC objectives, 40.5% prioritized quality healthcare, 36.3% emphasized health equity, and 23.3% focused on financial risk protection (Figure 2). The main sources of health insurance information were healthcare providers (37.4%), family and friends (24.4%), and social media (19.5%) (Figure 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth Insurance Utilization Barriers Among Insured and Enrollment Barriers Among Uninsured Participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on identified health insurance utilization barriers among insured and enrollment barriers among uninsured participants, the major challenge among the insured were limited coverage for certain conditions (22.5%), distance to healthcare facilities accounted for 16.4%, cost (12.7%) and long wait times was (12.7%). Other barriers were healthcare worker behavior (12.7%), difficulty in enrollment and renewal (9.9%), lack of transparency (7.0%), and limited access to healthcare (6.1%) (Figure 4a). For the uninsured, barriers included lack of awareness of available plans (33.3%), difficulty in enrollment (23.7%), cost (21.7%), lack of transparency and cost concerns (15.1%), and cultural or religious beliefs (6.2%) (Figure 4b).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealthcare-Related Factors Associated with Health Insurance Awareness and enrollment among Ilorin Respondents.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study examined how healthcare-related factors influence awareness and enrollment in health insurance amongst 415 participants in Ilorin. Awareness was generally higher among those who rated healthcare as excellent (63.2%) or good (64.3%), though the association was not significant (p = 0.084). A significant association was observed between awareness and knowledge of Universal Health Coverage (UHC) (p = 0.000); 64.9% of well-informed and 64.1% of moderately informed participants were aware of health insurance, compared to only 38.0% for the uninformed. Confidence in healthcare access was also significantly linked to awareness (p = 0.001), with the highest awareness (74.0%) among those very confident in accessing care.\u003c/p\u003e\n\u003cp\u003eIn contrast, health insurance enrollment was significantly associated with healthcare rating (p = 0.049) and confidence in access (p = 0.000). Enrollment was highest (50.0%) among participants who were very confident in accessing quality healthcare services, and lowest (18.3%) among those with little confidence. No significant associations were found between enrollment and UHC knowledge, financial hardship, or viewing healthcare as a right. Generally, confidence in healthcare access showed significant association with both awareness and enrollment, while UHC knowledge notably influenced awareness (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e \u003cem\u003eHealthcare-Related factors associated with health insurance awareness and enrollment among respondents in Ilorin, 2024. (n=415)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"619\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAwareness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnrollment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 317px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRating of Healthcare in Ilorin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eExcellent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e24(63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e14(36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e14(36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e24(63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e117(64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e65(35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e63(34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e119(65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e91(56.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e71(43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e37(22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e125(77.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e14(42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e19(57.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e7(21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e26(78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 317px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge About UHC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eWell Informed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e50(64.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e27(35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e23(29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e54(70.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eInformed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e166(64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e93(35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e82(31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e177(68.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNot Informed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e30(38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e49(62.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e16(20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e63(79.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 381px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIs access to healthcare a Fundamental Right?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e232(59.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e156(40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e115(29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e273(70.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e7(53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e6(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.704\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e4(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e9(69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e7(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e7(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e12(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 462px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYou have Financial Hardship accessing healthcare services?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e104(59.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e72(40.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.947\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e49(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e127(72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e142(59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e97(40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e72(30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e167(69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 317px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConfidence in Healthcare Access\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eVery Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e77(74.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e27(26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e52(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e52(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eSomewhat Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e90(59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e61(40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e38(25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e113(74.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNot Very Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e61(48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e65(51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e23(18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e103(81.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNot At All Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e18(52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e16(47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e8(23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e26(76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003cem\u003e\u0026nbsp;\u003c/em\u003e=\u003cem\u003eSignificant p-value (\u0026le; 0.05)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth Insurance Program Access and Satisfaction Among Study Respondents\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe association between health insurance program access and satisfaction revealed a significant relationship (P \u0026le; 0.05). Among NHIA users, 25(40.3%) were somewhat satisfied, while 13(39.4%) of Kwara Care users were very satisfied. In addition, 10(38.5%) of those with private health insurance were neutral toward their program (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e \u003cem\u003eAssociation between health insurance program access and level of satisfaction among insured participants sampled in Ilorin, 2024 (n=121)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVery satisfied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSomewhat Satisfied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeutral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSomewhat Dissatisfied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVery Dissatisfied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eNHIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e17(27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e25(40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e17(27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKwara Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13(39.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9(27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10(30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrivate Health Insurance Agency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9(34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10(38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (29.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43(35.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37 (30.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (0.83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (3.31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePredictor of Health Insurance Awareness Among the Study Respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe univariate logistic regression analysis from this study shows that marital status is a significant predictor of the awareness of health Insurance with Single individuals (adjusted OR = 0.416, 95% CI: 0.270-0.639, p = 0.000) having lesser chances of been aware of health insurance than those previously or presently married. Age-group was also a significant predictor of health insurance awareness with 18-27 years age-bracket presenting AOR = 0.613, 95% CI: 0.410-0.915, p = 0.017 and having lesser chance of been aware than those within 28 years and above. However, Formal sector members (AOR = 2.338, 95% CI: 1.469-3.723, p = 0.000) were more likely to be aware of health insurance than those working in informal sector and non-working group. Similarly, Healthcare workers (AOR = 2.740, 95% CI: 1.726-4.350, p = 0.000) were more likely to be awareness of health insurance as compared to those who are not healthcare workers. Education, gender and religion did not present as significant predictors of health insurance awareness (Table 6).\u003c/p\u003e\n\u003cp\u003eIn the Multivariate analysis, being an healthcare worker still remains a strong predictor of being aware of health insurance (AOR = 2.368, 95% CI: 1.446\u0026ndash;3.878, p = 0.001) compared to being a non-healthcare worker. Marital status was also a significant predictor, with single individuals (AOR = 0.366, 95% CI: 0.190\u0026ndash;0.704, p = 0.003) showing lesser chance of awareness than those married or previously married. Gender and religion, particularly Christianity (AOR = 0.915, 95% CI: 0.601\u0026ndash;1.392, p = 0.678) showed no significant association. Other factors such as Educational level and occupation were similarly also non-significant (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u0026nbsp;\u003c/strong\u003e\u003cem\u003eInfluence of Socio-demographics on Awareness of health insurance among\u0026nbsp;\u003c/em\u003e\u003cem\u003estudy Resampled in Ilorin, 2024\u003c/em\u003e\u003cem\u003e\u0026nbsp;(n=415)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"699\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCrude OR (CI)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAdjusted OR (CI)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1.284(0.866-1.903)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.248(0.811-1.919)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18-27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0.613(0.410-0.915)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.032(0.563-1.891)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.920\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e28 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0.416(0.270-0.639)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.366(0.190-0.704)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eMarried/Formerly (Divorced/Widowed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0.836(0.565-1.237)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.915(0.601-1.392)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eBasic/No formal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0.216(0.043-1.087)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.273(0.050-1.481)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0.649(0.293-1.439)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.841(0.367-1.929)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eHigher Institution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eFormal Sector\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2.338(1.469-3.723)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.081(0.584-1.999)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.805\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eInformal Sector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0.734(0.425-1.267)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.541(0.279-1.052)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNon-Working Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eHealthcareworker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2.740(1.726-4.350)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.368(1.446-3.878)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003cem\u003e\u0026nbsp;\u003c/em\u003e=\u003cem\u003eSignificant p-value \u0026le; 0.05; OR= Odd ratios\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictors of Health Insurance Utilization Among the Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the Univariate analysis, age was a significant predictor of the enrollment in health insurance with age group 18-27 (aOR = 0.415, 95% CI: 0.293-0.693, p = 0.000) being less likely to enroll in health insurance than individuals who are 28 years and above. Also, individuals who are single (aOR = 0.434, 95% CI: 0.281-0.670, p = 0.000) less likely to enroll in health insurance than individuals that are ever married. More so, Individuals working in formal sector (aOR = 2.655, 95% CI: 1.657-4.254, p = 0.000) more likely of health insurance enrollment than those in informal sector or non-working group. Additionally, Healthcare workers were more likely to enroll in health insurance (aOR =1.586, 95% CI: 1.014-2.479, p = 0.043). ,Also, health insurance awareness \u0026nbsp; is a strong predictor of health insurance enrollment (aOR = 14.859, 95% CI: 7.256-30.429, p = 0.000). However, Education, gender and religion are not a significant predictor of health insurance utilization (Table 7).\u003c/p\u003e\n\u003cp\u003eIn multivariate analysis, enrollment in health insurance was significantly associated with awareness, with those aware more likely to enroll (aOR = 13.893, 95% CI: 6.637\u0026ndash;29.080, p = 0.000). Surprisingly, after adjusting for cofounders, occupation, age group, marital status are significant predictors in the univariate analysis, became non-significant predictor of health insurance utilization. Also, gender, religion and been a healthcare worker does not stand as a significant predictor of health insurance utilization (Table 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7.\u0026nbsp;\u003c/strong\u003e\u003cem\u003eInfluence of respondents\u0026rsquo; socio-demographics on enrollment of health insurance (n=415)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCrude OR (CI)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAdjusted OR (CI)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1.493(0.976-2.285)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.225(0.744-2.015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.425\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e18-27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.415(0.293-0.693)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.583(0.295-1.155)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e28 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.434(0.281-0.670)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.062(0.507-2.225)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMarried/formerly Married (Divorced/Widowed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.860(0.563-1.314)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.895(0.549-1.458)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eBasic/No formal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.343(0.042-2.821)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.616(0.053-7.175)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.699\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1.067(0.451-2.526)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.884(0.672-5.279)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eHigher Institution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\\\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFormal Sector\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2.655(1.657-4.254)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.696(0.847-3.397)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eInformal Sector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1.177(0.621-2.231)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.144(0.503-2.601)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.749\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eNon-Working Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHealthcare worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1.586(1.014-2.479)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.043*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.913(0.538-1.549)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAwareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e14.859(7.256-30.429)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e13.893(6.637-29.080)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003eReference\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003cem\u003e\u0026nbsp;\u003c/em\u003e=\u003cem\u003eSignificant p-value \u0026le; 0.05; OR= Odd ratio\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe combined findings from this research provide a comprehensive and nuanced understanding of health insurance awareness and enrollment among residents of Ilorin, Nigeria, and highlight both progress and persistent challenges on the path toward universal health coverage (UHC).\u003c/p\u003e\n\u003cp\u003eA central finding of this study revealed 59.3% of participants reported being aware of health insurance, yet only 29.9% actually enrolled in it, leaving a significant 70.8% of the surveyed population uninsured. This is akin to some studies in Nigeria that reported low enrollment rates between 0.3% and 13.5% \u0026nbsp;[3,20-22]. However, Effiong et al. [10] reported an increase in health insurance enrollee in Kwara State of about 37.3% which focus only on Kwara care enrollment as compared this study assessing both NHIS, Kwara care and private health insurance. Although a study conducted among federal civil servant in Rivers State reported higher enrollment rate of 83.8% \u0026nbsp; [23]. These findings reflect\u0026nbsp;the regional variation in health insurance uptake, and low acceptance and reluctance to pay premiums, especially in the informal sector, which harbors over 70% of Nigeria's workers and non-working group [24].\u0026nbsp;However, our work reported a low coverage rate possibly because it was conducted among people working in formal sector, informal and those who are in non-working groups. This could imply that the health insurance has difficulties breaking into the unorganized sector. Additionally, although making up half of all respondents, students (non-working group) and younger adults were primarily uninsured in the majority of our study states, indicating unique obstacles to young adults' coverage under the program [10].\u003c/p\u003e\n\u003cp\u003eThe gap between awareness and enrollment is not only peculiar to Ilorin, but it mirrors national trends across many Nigerian states, where fewer than 10% of the populace are enrolled in the NHIS despite its introduction over two decades ago [3]. The relatively high awareness rate in Ilorin may be attributed to its urban setting and the predominance of young, educated participants who had tertiary education and also an effect of the previous community based health insurance in kwara state that’s has been running in 2006 and the subsequent state health insurance which runs in 2018 has contributed to raising significant level of awareness about health insurance with community mobilization and engagement tactics [3,7,\u0026nbsp;25]. Previous research has consistently shown that higher education levels and formal employment are associated with greater awareness and uptake of health insurance [3].\u003c/p\u003e\n\u003cp\u003eIn this study, of the 29.2% enrollment rate, NHIA (51.2%) was the most accessed insurance package. Despite this relatively high awareness, actual enrollment in health insurance remains low, especially among informal sector workers and non-working groups, as buttressed by similar studies conducted in Nigeria which reported enrollment rate between 6.7 and 21.1% [13,26] and a study conducted by Mwinuka et al. [27] among informal sector in Tazania reporting enrollment rate of 9.1%. The voluntary nature of health insurance enrollment in Nigeria, particularly for those in the informal sector, continues to be a significant barrier. Many informal workers lack stable incomes, making regular premium payments difficult [7,26]. This study and several other study also reported that cost and difficulty in enrollment were among the most frequently cited barriers for the uninsured, alongside lack of awareness of available plans [7,26]. These challenges are compounded by weak legal frameworks, inadequate government funding, and inefficiencies in the scheme’s administration, as noted in broader literature [13,26].\u003c/p\u003e\n\u003cp\u003eIn this study, awareness and utilization were significantly higher among formal sector workers, individuals with tertiary education, younger and single individuals. This is in line with findings from Adewole et al. [3], who reported that education and employment type are strong predictors of health insurance awareness and utilization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe barriers to health insurance utilization observed in this work are multifaceted affecting both the insured and uninsured. This study reported lack of awareness of available plans, difficulty in enrollment, and cost as the major barrier to enrollment of health insurance among uninsured participants. However, those who are insured expressed dissatisfaction which stemmed from limited coverage for certain conditions, distance to healthcare facilities, cost, long waiting times, negative healthcare worker behavior, and difficulty with enrollment and renewal. These findings are consistent with previous research showing that administrative complexity, limited benefit packages, and negative experiences with healthcare providers can discourage both enrollment and continued participation [3,7,26,28]. Additionally, the study highlights other factors such as low level of trust in government social policies, poverty, and lack of trust in managing health insurance scheme funds, while disagreements from cultural and pious beliefs are also frequent barriers in Nigeria and other similar settings [28-30]. The complexity of the enrollment process and the lack of tailored information for informal sector workers further exacerbate these challenges [31]\u003c/p\u003e\n\u003cp\u003eSurprisingly, this study reported that, only 29.8% of insured participants expressed satisfaction with their healthcare access, though most of them (35.5%) were just partially satisfied with their insurance services. A large proportion reported only occasional access to healthcare services. This suggests that even for those who are insured, the perceived value and quality of insurance programs may be limited, potentially undermining trust and willingness to recommend or renew coverage [3,7]. The limited coverage for certain conditions and the distance to healthcare facilities were notable sources of dissatisfaction among the insured [3,7].\u003c/p\u003e\n\u003cp\u003eThis study found financial hardship not to be significantly associated with either awareness or utilization of health insurance. Enrollment rates were similar among those experiencing financial hardship and those who were not. However, confidence in healthcare access was significantly associated with both awareness and enrollment compared to much lower rates among those with low or no confidence. This finding aligns with broader evidence that trust in health systems is a critical driver of insurance [32].\u003c/p\u003e\n\u003cp\u003eHealthcare providers were the main source of information about health insurance, followed by family/friends and social media. This highlights the influential role of trusted intermediaries and the potential for leveraging these channels in future awareness and enrollment campaigns. The role of healthcare providers as the primary source of information suggests that interventions aimed at increasing awareness and uptake can benefit by involving healthcare workers as advocates and educators [3,7]. Also, all insured participants reported satisfaction to the program they were enrolled in with just few being dissatisfied, reflecting feelings of adequacy in the services they were getting from the program.\u003c/p\u003e\n\u003cp\u003eIn this study, the major access to information about health insurance was reported to be from healthcare workers which makes an healthcare provider to be more aware of health insurance awareness. Although awareness and information access by healthcare workers related to health insurance, does not translate to its enrollment. This could probably be attributed to perceived feelings of self confidence in catering for their health services when they needed it. \u0026nbsp;Also,\u0026nbsp;the study highlighted that awareness plays a crucial role in health insurance enrollment, as individuals with better knowledge about the scheme were more likely to participate. This suggests that to improve the enrollment rate, the state needs to strengthen the awareness level and community engagement in every sector, most especially the informal sector and non-working group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePolicy Implications and Recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn summary, while awareness of health insurance in Ilorin is higher than national averages, enrollment remains low due to a complex interplay of socioeconomic, structural, and perceptual barriers. Addressing these challenges will require multifaceted interventions, including:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eTargeted Awareness Campaigns: Leveraging healthcare providers, social media, and community leaders to disseminate information, especially to less-educated and informal sector populations.\u003c/li\u003e\n \u003cli\u003eSimplification of Enrollment Processes: Reducing administrative complexity and making enrollment more accessible for informal workers and vulnerable groups.\u003c/li\u003e\n \u003cli\u003eExpansion of Coverage Options: Broadening the benefit packages to cover more conditions and services and ensuring that coverage meets the needs of diverse populations.\u003c/li\u003e\n \u003cli\u003eBuilding Trust and Satisfaction: Improving the quality of healthcare services, addressing negative provider behaviors, and ensuring transparency in fund management to foster trust in the health insurance system.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eInnovative Communication Strategies: Developing culturally appropriate, easy-to-understand educational materials and community-based outreach programs, as demonstrated by successful models in other Nigerian states.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe strength of this study lies the findings generated from this study which is unveils gaps in awareness and enrollment in health insurance and the barriers associated with enrollment and utilization of health insurance which is relevants to achieving UHC goals in Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe limitations of this study lies on the cross-sectional study design used, which limits the ability to observe changes in awareness or enrollment over time or to track the impact of interventions. Also, the absence of qualitative data (e.g., focus group discussions, in-depth interviews) might limit a deeper understanding of the \"why\" behind some of the observed behaviors and perceptions, particularly concerning trust, cultural beliefs, or specific administrative frustrations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study on health insurance in Ilorin, Nigeria, reveals a significant gap between awareness and enrollment. While most residents are aware of health insurance, only few individuals are enrolled, leaving majority uninsured. This trend mirrors national challenges, particularly affecting informal sector workers and vulnerable groups. Despite progress in awareness, significant effort is needed to boost health insurance enrollment and effective utilization in Ilorin. This requires targeted interventions, policy reforms, and increased stakeholder engagement to make health insurance accessible, affordable, and trustworthy for everyone.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledged the Kwara State ministry of health ethical review committee for their contributions and kind support towards the project.\u0026nbsp;We also acknowledged the support of Ogunniyi Oluwanifemi, Abdulhameed Rodiat, Arinde Wisdom Emmanuel,\u0026nbsp;Olaleye David, Alawonla Yetunde Arinola, Lolade Albarika, Akingbade Esther Adeola in the collection and collation of the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Kwara State Ministry of Health’s ethical review committee based in Ilorin gave the ethical approval with reference number: ERC/MOH/2024/06/312 for the study. The research was carried out in accordance with the Helsinki declaration act.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants gave their consents to participate in the research work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare no conflict of Interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no external source of funding for this research work\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated are embedded in this manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTJO: Conceptualized the study idea, took part in data collection, data analysis, writing the study’s first draft, proofreading and editing of the manuscript. SSY \u0026amp; OAO: Conceptualization of the study, data collection, and writing of the manuscript. MOA \u0026amp; OPO: Conceptualization of the study, design of data collection materials, data collection and writing of the second Manuscript. MZP: Review, Proofreading and editing of the final manuscript. ARE: Writing of the Manuscript. RDD: Headed the study discussion, Supervision, Proofreading and editing of the manuscript. FBE: \u0026nbsp; Supervised, review, Proofreading and editing of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbiiro GA, De Allegri M. Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates. BMC International Health and Human Rights. 2015;(1). doi:10.1186/s12914-015-0056-9\u003c/li\u003e\n \u003cli\u003eWHO. Universal health coverage (UHC). World Health Organization (WHO). Published 2025. 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PLOS ONE. 2019;(8):e0220558. doi:10.1371/journal.pone.0220558\u003c/li\u003e\n \u003cli\u003ePricewaterhouseCoopers (PwC) Nigeria. Sustainability of State Health Insurance Schemes in Nigeria Beyond the Launch. Published 2019. Accessed September 17, 2025. https://www.pwc.com/ng/en/assets/pdf/sustainability-state-health-insurance-nigeria.pdf\u003c/li\u003e\n \u003cli\u003eAregbeshola BS, Khan SM. Predictors of Enrolment in the National Health Insurance Scheme Among Women of Reproductive Age in Nigeria. International Journal of Health Policy and Management. 2018;(11):1015-1023. doi:10.15171/ijhpm.2018.68\u003c/li\u003e\n \u003cli\u003eAdedeji AS, Doyin A, Kayode OG, Ayodele AA. Knowledge, Practice and Willingness to Participate in Community Health Insurance Scheme among Households in Nigerian Capital City. Sudan Journal of Medical Sciences. 2017;(1):9-18. doi:10.18502/sjms.v12i1.854\u003c/li\u003e\n \u003cli\u003eWikipedia. Ilorin - Wikipedia. Wikipedia, the free encyclopedia. Published 2024. Accessed August 17, 2025. https://en.wikipedia.org/wiki/Ilorin\u003c/li\u003e\n \u003cli\u003eBritannica. Ilorin. Encyclop\u0026aelig;dia Britannica. Published 2024. Accessed August 17, 2025. https://www.britannica.com/place/Ilorin\u003c/li\u003e\n \u003cli\u003eOsunde NR, Olorunfemi O, Oduyemi RO. Awareness, willingness, and challenges of the informal sector toward state National Health Insurance Services in Benin City, Nigeria. MGM Journal of Medical Sciences. 2023;(1):30-37. doi:10.4103/mgmj.mgmj_191_22\u003c/li\u003e\n \u003cli\u003eCelestine E, Achama E, Isaac O, Somtochukwu O. Knowledge, attitudes to, and utilization of the national health insurance scheme (NHIS) among health workers in the university of Nigeria teaching hospital (UNTH), Ituku-ozalla, Enugu state, Nigeria. International Journal of Research -Granthaalayah. 2018;(1):1-22. doi:10.29121/granthaalayah.v6.i1.2018.1590\u003c/li\u003e\n \u003cli\u003eAbiola AO, Ladi-Akinyemi TW, Oyeleye OA, Oyeleke GK, Olowoselu OI, Abdulkareem AT. Knowledge and utilisation of National Health Insurance Scheme among adult patients attending a tertiary health facility in Lagos State, South-Western Nigeria. African Journal of Primary Health Care \u0026amp;amp; Family Medicine. 2019;(1). doi:10.4102/phcfm.v11i1.2018\u003c/li\u003e\n \u003cli\u003eOkusanya BO, Roberts AA, Akinsola OJ, Oye-Adeniran BA. Birth plans and health insurance enrolment of pregnant women: a cross-sectional survey at two secondary health facilities in Lagos, Nigeria. The Journal of Maternal-Fetal \u0026amp;amp; Neonatal Medicine. Published online October 20, 2015:1-5. doi:10.3109/14767058.2015.1094790\u003c/li\u003e\n \u003cli\u003eOlugbenga-Bello A, Adebimpe W. Knowledge and attitude of civil servants in Osun state, Southwestern Nigeria towards the national health insurance. Niger J Clin Pract. 2010;(13(4)):421-426.\u003c/li\u003e\n \u003cli\u003eAdebiyi O, Adeniji FO. Factors Affecting Utilization of the National Health Insurance Scheme by Federal Civil Servants in Rivers State, Nigeria. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. Published online January 2021. doi:10.1177/00469580211017626\u003c/li\u003e\n \u003cli\u003eOkebukola PO, Brieger WR. Providing Universal Health Insurance Coverage in Nigeria. International Quarterly of Community Health Education. 2016;(4):241-246. doi:10.1177/0272684x16657451\u003c/li\u003e\n \u003cli\u003eBolarinwa OA, Akande TM, Janssens W, Boahene K, de Wit TR. Effects of a temporary suspension of community-based health insurance in Kwara State, North-Central, Nigeria. Pan African Medical Journal. Published online 2022. doi:10.11604/pamj.2022.41.10.27978\u003c/li\u003e\n \u003cli\u003eAdewole DA, Akanbi SA, Osungbade KO, Bello S. Expanding health insurance scheme in the informal sector in Nigeria: awareness as a potential demand-side tool. Pan African Medical Journal. Published online 2017. doi:10.11604/pamj.2017.27.52.11092\u003c/li\u003e\n \u003cli\u003eMwinuka B, Echoka E, Nyaberi J. Accessibility of Health Insurance among Informal Sector Workers in Dar es Salaam Tanzania: What Are the Barriers? Open Journal of Social Sciences. 2023;(06):44-59. doi:10.4236/jss.2023.116004\u003c/li\u003e\n \u003cli\u003eAdewole DA, Adebayo AM, Udeh EI, Shaahu VN, Dairo MD. Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria. The American Society of Tropical Medicine and Hygiene. 2015;(3):648-654. doi:10.4269/ajtmh.14-0245\u003c/li\u003e\n \u003cli\u003eOnyemaechi SB, Ezenwaka UR. Leveraging Innovative Financing Strategy to Increase Coverage and Resources Among Informal Sector for Social Health Insurance Within the Nigerian Context of Devolution: Evidence From Adoption Model Implementation. Frontiers in Public Health. Published online July 14, 2022. doi:10.3389/fpubh.2022.894330\u003c/li\u003e\n \u003cli\u003eObasi O, Ezeh C. Analysis of Social Health Insurance in Nigeria and Its Challenges . International Journal of Public Administration. 2024;(3(2)):420-437.\u003c/li\u003e\n \u003cli\u003eOnasanya AA. Increasing health insurance enrolment in the informal economic sector. Journal of Global Health. 2020;(1). doi:10.7189/jogh.10.010329\u003c/li\u003e\n \u003cli\u003eOnwujekwe OE, Uzochukwu BS, Obikeze EN, et al. Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria. BMC Health Services Research. 2010;(1). doi:10.1186/1472-6963-10-67\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health Insurance, Awareness, Health Coverage, Out-of-Pocket Payment, Kwara State, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-7754583/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7754583/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e\u003cp\u003eHealth insurance, intended to reduce financial burdens and enhance affordability of healthcare services, remains a relatively new concept in Nigeria. Despite efforts to expand its coverage, approximately 90% of Nigerians lacked health insurance as of 2024. This study assessed the awareness, utilization, and the socioeconomic and healthcare factors influencing health insurance uptake in Ilorin, Kwara State.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eThe study employed a cross-sectional design conducted among adults from the ages of 18 years and 70 years within Ilorin, Kwara State, Nigeria. Data was collected within the period of 3 months (July to September 2024) using semi-structured questionnaires covering the awareness, utilization and associated factor to health insurance uptake. Descriptive statistics, chi-square and logistic regression were conducted using SPSS version 25.0 whilst setting statistical significance with p-values at \u0026le;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e\u003cp\u003eOf the 415 participants, 243 (59.3%) were aware of health insurance, but only 121 (29.9%) are enrolled, with healthcare providers (37.4%) being the main source. The National Health Insurance Authority (NHIA) has the highest enrollment rate (51.2%). Among the insured, the most reported challenge was limited coverage for certain conditions (22.5%), while the uninsured mostly reported lack of awareness of available plans (33.3%). However, being a healthcare worker significantly increased awareness of health insurance (AOR\u0026thinsp;=\u0026thinsp;2.368, 95% CI: 1.446\u0026ndash;3.878, p\u0026thinsp;=\u0026thinsp;0.001); single individuals showed (AOR\u0026thinsp;=\u0026thinsp;0.366, 95% CI: 0.190\u0026ndash;0.704, p\u0026thinsp;=\u0026thinsp;0.003) lesser awareness. Additionally, those who were aware of health insurance were more likely to enroll (AOR\u0026thinsp;=\u0026thinsp;13.893, 95% CI: 6.637\u0026ndash;29.080, p\u0026thinsp;=\u0026thinsp;0.000) and being a healthcare worker was not significantly linked to enrollment (AOR\u0026thinsp;=\u0026thinsp;0.913, 95% CI: 0.538\u0026ndash;1.549, p\u0026thinsp;=\u0026thinsp;0.737).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eDespite moderate awareness of health insurance, actual enrollment remained low, driven more by perceived healthcare access and system confidence than by knowledge or affordability. Limited coverage and low enrollment further hinder uptake. Targeted interventions addressing socio-economic and healthcare system barriers are essential to improve health insurance utilization and advance progress toward Universal Health Coverage (UHC).\u003c/p\u003e","manuscriptTitle":"Socio-economic and Healthcare Determinants of Health Insurance Awareness and Enrollment in Ilorin, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 09:28:05","doi":"10.21203/rs.3.rs-7754583/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"729e5e61-4e18-434c-ad96-fb27989c0e71","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-08T14:48:34+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T16:30:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 09:28:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7754583","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7754583","identity":"rs-7754583","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}