Barriers and Facilitators to Patient Accessibility of Nuclear Medicine Services in Nigeria: A Social Science Perspective

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Despite the clinical importance of nuclear medicine in managing cancer and non-communicable diseases, patient-centred research exploring the social dimensions of accessibility is limited. This study examined the barriers and facilitators influencing patient accessibility to nuclear medicine services at University College Hospital (UCH), Ibadan, Nigeria, from a social science perspective. Methods A qualitative, descriptive, cross-sectional study was conducted, using Max Weber’s Social Action Theory as the theoretical framework. Data was collected through 36 in-depth interviews with patients, 16 case studies, and 11 key informant interviews with healthcare providers and administrators. The data were analysed thematically using MaxQDA software. Results Three significant barriers emerged. First, financial constraints proved overwhelming, with patients paying between ₦80,000 and ₦750,000 for radioiodine therapy alone, excluding costs for accommodation, transportation, and subsistence. Second, geographic accessibility posed significant challenges, as patients had to travel long distances from across Nigeria due to the concentration of services in Ibadan. Thirdly, limited-service availability, including shortages of radiopharmaceuticals and equipment, further constrained access. Social support networks, particularly family and community contributions, emerged as the primary facilitator, enabling patients to overcome financial barriers through collective resource mobilisation. Conclusion Patient accessibility to nuclear medicine services in Nigeria is severely constrained by financial, geographic, and systemic barriers. The heavy reliance on informal social support networks highlights the absence of adequate health financing mechanisms. Policy interventions should prioritise expanding health insurance coverage for cancer care, expanding nuclear medicine services, and strengthening healthcare financing systems. Patient accessibility nuclear medicine healthcare barriers social support networks Nigeria health equity Introduction Nuclear medicine plays an indispensable role in the diagnosis and treatment of cancer and non-communicable diseases, which are increasingly being recognised as major public health challenges in low- and middle-income countries. In Nigeria, non-communicable diseases account for approximately 29% of all deaths, with cancer representing a significant and growing burden [ 1 ]. Nuclear medicine techniques, particularly radioiodine therapy for thyroid cancer and diagnostic imaging using radiopharmaceuticals, offer critical therapeutic and diagnostic capabilities that are often unavailable through conventional medical approaches [ 2 ]. Despite these benefits, access to nuclear medicine services in sub-Saharan Africa remains severely limited. The World Health Organisation estimates that over 90% of the global population in low- and middle-income countries lacks adequate access to essential diagnostic imaging, including nuclear medicine [ 3 ]. In Nigeria, nuclear medicine services are only available at two tertiary and other private hospitals located in major urban centres, creating significant geographic and socioeconomic barriers for patients requiring these specialised services [ 4 ]. While existing literature on nuclear medicine in Nigeria has predominantly focused on clinical outcomes, technical challenges, and awareness among healthcare providers [ 5 – 8 ], there is a notable absence of patient-centred research examining the social, economic, and structural factors that shape access to these services. Previous studies by Alonge and Okoje demonstrated high awareness of nuclear medicine among Nigerian medical practitioners. However, Orunmuyi and colleagues reported surprising underutilization of these services [ 5 , 9 ]. This paradox suggests that factors beyond clinical awareness, including patient-level barriers and systemic healthcare challenges, significantly influence accessibility. The social science perspective offers valuable insights into understanding healthcare accessibility as a multidimensional phenomenon shaped by individual agency, social structures, economic constraints, and institutional arrangements [ 10 ]. By examining patient experiences and the social context of healthcare seeking, this study addresses a critical gap in understanding how Nigerians navigate access to nuclear medicine services. This study is grounded in Max Weber’s Social Action Theory, which emphasises understanding human behaviour through the meanings and motivations individuals attach to their actions [ 11 ]. Weber identified four types of social action: instrumental-rational action, oriented toward achieving specific goals; value-rational action, guided by ethical or religious values; affectual action, driven by emotions; and traditional action, based on customs and habits. In the context of healthcare seeking, patients’ decisions to access nuclear medicine services can be understood as instrumental-rational actions aimed at achieving health goals. Still, these actions are constrained and facilitated by social, economic, and structural factors. This theoretical lens allows us to examine how patients make decisions about seeking nuclear medicine services, how they mobilise resources through social networks, and how structural barriers shape their healthcare experiences. This study aimed to identify and analyse the barriers that impede patient accessibility to nuclear medicine services at UCH, Ibadan, to examine the facilitators that enable patients to overcome these barriers, to explore the role of social support networks in healthcare access, and to provide evidence-based recommendations for policy and practice to improve equitable access to nuclear medicine services in Nigeria. Healthcare accessibility is a complex, multidimensional construct that extends beyond mere physical availability of services. Levesque and colleagues conceptualised access as occurring at the interface between health systems and populations, encompassing five dimensions: approachability, acceptability, availability and accommodation, affordability, and appropriateness [ 12 ]. This framework recognises that access is determined not only by supply-side factors such as healthcare system characteristics but also by demand-side factors, including population characteristics and capabilities. Penchansky and Thomas earlier proposed five dimensions of access: availability, accessibility, accommodation, affordability, and acceptability [ 13 ]. Saurma later modified this framework to reflect contemporary healthcare challenges better, emphasising the dynamic interaction between healthcare systems and patient populations [ 14 ]. These frameworks emphasise that improving access necessitates addressing multiple barriers simultaneously across various system levels. Nuclear medicine services in developing countries face distinctive challenges related to infrastructure, workforce, regulatory frameworks, and supply chains [ 15 , 16 ]. The International Atomic Energy Agency has documented persistent gaps in nuclear medicine capacity across Africa, with most countries having fewer than one nuclear medicine facility per 10 million population [ 17 ]. Recent studies have identified several critical barriers that constrain service delivery and patient access. Infrastructure and equipment limitations represent a fundamental challenge. The limited availability of gamma cameras, PET-CT scanners, and radiopharmaceutical production facilities constrains service delivery [ 18 ]. Capital-intensive equipment requirements and dependence on imported technology create sustainability challenges [ 19 ]. Workforce shortages further exacerbate these problems, as the insufficient number of trained nuclear medicine physicians, medical physicists, and radiopharmacists limits service capacity [ 20 ]. Brain drain and limited training opportunities exacerbate workforce gaps [ 21 ]. Supply chain vulnerabilities pose another significant barrier. Dependence on single suppliers for radiopharmaceuticals and radionuclide generators can lead to supply disruptions [ 22 ]. The short half-life of many radiopharmaceuticals necessitates reliable and timely delivery systems, which are often lacking in resource-limited settings [ 23 ]. Regulatory complexity and institutional incoherence increase operational costs and threaten service sustainability [ 24 ]. High out-of-pocket costs for patients, combined with limited insurance coverage for specialised diagnostic and therapeutic services, create significant affordability barriers [ 25 , 26 ]. Nigeria’s healthcare system is not unfamiliar with significant inequities in access, quality, and outcomes [ 27 ]. Geographic disparities are pronounced, with advanced medical services concentrated in urban tertiary hospitals while rural populations face substantial distance and transportation barriers [ 28 ]. Otu documented that many Nigerians must travel over 100 kilometres to access specialised healthcare services, incurring significant time and financial costs [ 28 ]. Financial barriers are particularly acute in Nigeria’s predominantly out-of-pocket healthcare financing system. The National Health Insurance Scheme covers less than 5% of the population, and even among the insured, coverage for advanced diagnostics and cancer treatment is limited [ 29 ]. Catastrophic health expenditure, defined as health spending exceeding 40% of household capacity to pay, is common among Nigerian families seeking care for serious illnesses [ 30 ]. Social support networks play a crucial role in healthcare access in Nigeria. Extended family systems, community associations, and religious organisations often mobilise resources to support individuals facing health crises [ 31 ]. However, reliance on informal support mechanisms is both a facilitator and an indicator of systemic failures in healthcare financing [ 32 ]. This study addresses a critical evidence gap by providing patient-centered insights into accessibility barriers and facilitators for nuclear medicine services in Nigeria. Methods Study Design and Setting This study employed a qualitative descriptive cross-sectional design to explore patient experiences and perspectives on accessing nuclear medicine services. Qualitative methods are particularly suited to understanding complex social phenomena, capturing the meanings individuals attach to their experiences, and identifying contextual factors that shape health behaviours [ 33 ]. The research was conducted at the University College Hospital (UCH), Ibadan, one of Nigeria’s premier tertiary healthcare institutions and a leading centre for nuclear medicine services. UCH’s Nuclear Medicine Department provides diagnostic and therapeutic services, including radioiodine therapy for thyroid disorders, bone scans, renal studies, and other specialised procedures. As one of the few functional nuclear medicine centers in Nigeria, UCH serves patients from across the country, making it an ideal setting for examining accessibility challenges. Study population and participants The study population comprised three groups: patients who had accessed or were accessing nuclear medicine services at UCH, healthcare providers including nuclear medicine physicians, radiographers, and nurses, and hospital administrators involved in service delivery and administration. Purposive sampling was used to select information-rich cases that could provide in-depth insights into accessibility issues. Patients were selected to ensure diversity in terms of type of nuclear medicine service accessed, geographic origin, socioeconomic background, gender and age. Healthcare providers and administrators were selected based on their roles and experience in nuclear medicine service delivery. Data collection continued until thematic saturation was achieved, resulting in 36 in-depth interviews with patients, 16 case studies of patient journeys, and 11 key informant interviews with healthcare providers and administrators. Semi-structured interviews were conducted with patients to explore their experiences accessing nuclear medicine services. Interview guides covered topics including pathways to UCH and referral processes, financial costs and coping strategies, transportation and accommodation challenges, social support mobilisation, perceptions of service quality and availability, and suggestions for improving accessibility. Detailed case studies documented patient journeys from initial diagnosis through treatment completion, capturing the full spectrum of challenges encountered and strategies employed to overcome barriers. Interviews with healthcare providers and administrators explored operational challenges in service delivery, patient obstacles, institutional constraints and facilitators, and policy perspectives on improving accessibility. Interviews were conducted in either English or Yoruba, the predominant local language, at the participant's preference. All interviews were audio-recorded with participant consent and transcribed verbatim. Yoruba interviews were translated into English by bilingual research assistants, with back-translation checks to ensure accuracy. Interviews lasted between 45 and 90 minutes and were conducted in private settings within the hospital to ensure confidentiality. Field notes were taken during and after interviews to capture non-verbal cues and contextual observations. Data Analysis Data was analyzed using thematic analysis, following Braun and Clarke’s six-phase framework [ 34 ]. The process involved familiarisation with data through repeated reading of transcripts, generating initial codes systematically across the dataset, searching for themes by collating codes into potential themes, reviewing themes to ensure they work in relation to coded extracts and the entire dataset, defining and naming themes, and producing the final report with vivid examples. MaxQDA software was used to facilitate data management, coding, and theme development. The analytical process was iterative, with constant comparison between emerging themes and raw data to ensure interpretations were grounded in participant accounts. Ethical approval was obtained from the University of Ibadan/University College Hospital Institutional Review Board. All participants provided written informed consent after receiving detailed information about the study’s purpose, procedures, risks, and benefits. Participation was voluntary, and participants were informed of their right to withdraw at any time without consequences. Confidentiality was maintained through the use of pseudonyms in transcripts and reports, secure data storage, and restricted access to the research team. Given the sensitive nature of discussing financial challenges and health conditions, interviews were conducted with empathy and cultural sensitivity. Several strategies were employed to enhance the trustworthiness of the findings. Credibility was ensured through prolonged field engagement, triangulation of data sources (including patients, providers, and administrators), and member checking with selected participants. Transferability was supported by a detailed description of the context, participants, and findings, enabling readers to assess the applicability to other settings. Dependability was maintained through an audit trail of analytical decisions and systematic coding procedures. Confirmability was achieved through reflexivity regarding researchers’ positionality and potential biases. Results Three major themes emerged from the data analysis: financial barriers and coping strategies, geographic accessibility challenges, and social support networks as facilitators. Each theme is presented below, accompanied by illustrative quotations. Financial Barriers and Coping Strategies Financial constraints emerged as the most significant barrier to accessing nuclear medicine services. Participants described multiple layers of costs that extended far beyond the direct medical expenses. The cost of radioiodine therapy ranged from ₦80,000 ( $ 200) to ₦750,000 ( $ 1,800 USD), based on the exchange rates at the time of the study. One patient, a 45-year-old female teacher with thyroid cancer, expressed her shock at the treatment costs: “When they told me the cost of the treatment, I was shocked. ₦500,000 for just the capsule! Where will I get that kind of money? I am a teacher, my salary is ₦70,000 per month. Even if I save everything for a year without eating, it won’t be enough.” Diagnostic procedures, while less expensive than therapeutic interventions, still imposed significant financial burdens. A 58-year-old male patient with prostate cancer explained: “The bone scan cost ₦35,000 ( $ 88), then they said I need another test, another ₦40,000 ( $ 100). Every time I come, there is another bill. I have spent over ₦200,000 on tests alone, and they haven’t even started the main treatment.” Beyond direct medical expenses, patients incurred substantial indirect costs, including transportation, accommodation, and subsistence expenses. Many patients travelled from distant states and required extended stays in Ibadan for treatment and follow-up. A 52-year-old male patient from Maiduguri described his experience: “I came from Maiduguri. The transport alone cost ₦25,000 ( $ 63) one way. I had to stay in Ibadan for three weeks because of the isolation period after the treatment. Accommodation was ₦2,000 ( $ 5) per night, then food every day, and it all adds up. In total, apart from the treatment itself, I spent almost ₦150,000 ( $ 375) on these other things.” For patients from rural areas, the need to stay in urban accommodation represents a significant financial and social burden, separating them from family support systems and income-generating activities. Many patients experienced income loss due to extended absences from work during treatment and recovery periods. A 41-year-old self-employed female patient explained: “I am self-employed, I have a small shop. When I came here for treatment, I had to close the shop for one month. No sales, no income, but the expenses kept coming. My business suffered seriously.” Faced with overwhelming costs, patients employed various coping strategies, most of which had long-term negative consequences. Many patients exhausted their life savings or sold assets such as land, vehicles, or jewelry to finance treatment. A 60-year-old male patient with thyroid cancer stated: “I sold my car and a plot of land I was keeping for my children’s future. What choice did I have? It’s life or death.” Patients commonly borrowed money from family members, friends, or informal lenders, often at high interest rates, creating long-term debt burdens. A 48-year-old female patient explained: “I borrowed from everywhere—family, friends, even my cooperative society. Now I am in serious debt. I don’t know how I will pay back all this money.” Some patients delayed treatment while attempting to raise funds, potentially compromising health outcomes. Others abandoned treatment entirely when financial resources were exhausted. A 55-year-old male patient admitted: “I was supposed to come back for follow-up three months ago, but I couldn’t afford the transport and the tests. I’m just managing at home and praying.” A nuclear medicine physician confirmed this pattern: “We see patients who start treatment and then disappear because they can’t afford to continue. It’s heartbreaking because we know their condition may deteriorate without completing the treatment.” The absence of insurance coverage for nuclear medicine services exacerbates the financial barriers. Even patients enrolled in the National Health Insurance Scheme found that their coverage excluded advanced diagnostic and therapeutic procedures. A 51-year-old male patient expressed his frustration: “I have health insurance from my work, but when I asked, they said nuclear medicine is not covered. So what is the point of having insurance if it doesn’t cover when you really need it?” A hospital administrator explained: “The insurance schemes in Nigeria have minimal coverage. They cover basic things like consultation and common drugs, but not expensive procedures like radioiodine therapy or PET scans. So patients still have to pay out of pocket for these services.” Geographic Accessibility Challenges Geographic barriers emerged as a significant constraint, reflecting the skewed distribution of nuclear medicine services in Nigeria. Patients traveled from all regions of Nigeria to access services at UCH, Ibadan. Travel distances ranged from 50 kilometres for patients within Oyo State to over 1,000 kilometres for those from distant states. A 49-year-old male patient from Sokoto described his journey: “I travelled from Sokoto; it took me two days by road. The journey itself was exhausting, and I was already weak from my illness. But there is no nuclear medicine in Sokoto, so I had no choice.” The concentration of services in a few urban centres meant that patients in rural and remote areas faced particularly severe challenges to accessibility. Long-distance travel posed multiple challenges including high costs, physical discomfort for ill patients, and safety concerns, particularly given Nigeria’s security situation in some regions. A 44-year-old female patient expressed her fears: “The roads are bad, and there is insecurity in some areas. I was afraid to travel, but I had to. The bus was uncomfortable, and by the time I reached Ibadan, I was in so much pain.” For patients requiring multiple visits for treatment and follow-up, repeated long-distance travel multiplied these challenges. Patients from distant locations required accommodation in Ibadan, often for extended periods. Finding affordable and safe accommodation near the hospital was challenging, particularly for patients with limited financial resources. A 38-year-old female patient explained, “I didn’t know anyone in Ibadan. I had to look for a place to stay. The hotels near the hospital are expensive. I found a small room in a local area, but it was not comfortable and quite far from the hospital.” Some patients stayed with relatives or friends in Ibadan, but this option was not available to everyone and sometimes created social obligations and discomfort. Geographic distance affected not only patients but also family members who served as caregivers. Family members often had to choose between accompanying patients, incurring additional costs and time away from home, or remaining behind, leaving patients without adequate support. A 47-year-old male patient with thyroid cancer reflected: “My wife wanted to come with me, but we have young children at home. She couldn’t leave them for weeks. So I came alone. It was lonely and difficult, especially during the isolation period after treatment.” Healthcare providers recognised that geographic barriers contributed to late presentation, treatment delays, and poor follow-up compliance. A nuclear medicine physician observed: “Many patients come to us very late because they have been trying other treatments closer to home. By the time they reach us, the disease is advanced. And then after treatment, follow-up is poor because they live so far away.” Social Support Networks as Facilitators Despite overwhelming barriers, social support networks emerged as the primary facilitator enabling patients to access nuclear medicine services. These networks mobilised financial, emotional, and practical support. Extended family systems played a crucial role in pooling financial resources for treatment. A 43-year-old female patient with thyroid cancer described her family’s support: “My brothers and sisters contributed money. My uncle gave ₦100,000, ( $ 250) my brother gave ₦80,000 ( $ 200), and my sister sold some jewellery. Without my family, I could never have afforded this treatment.” Family support extended beyond finances to include emotional support, caregiving, and advocacy within the healthcare system. A 62-year-old female patient explained, “My son came with me and stayed throughout the treatment. He helped me communicate with the doctors, collected my medications, and took care of me. I don’t know what I would have done without him.” Community associations, religious congregations, and social groups mobilised collective support for members facing health crises. A 54-year-old male patient with thyroid cancer shared: “My church organised a fundraiser for me. They announced my situation, and members contributed what they could. Some gave ₦5,000, while others gave ₦10,000. In the end, they raised ₦300,000 ( $ 750) for me. I was so touched by their generosity.” These collective support mechanisms reflected strong social solidarity but also highlighted the absence of formal safety nets. Some patients received financial assistance from employers or workplace cooperative societies. A 46-year-old female patient noted: “My office organised a contribution for me. My colleagues were very supportive. The cooperative society also gave me a loan at a low interest rate. That helped a lot.” However, this form of support was limited to formal sector employees, excluding most Nigerians working in the informal sector. A few younger patients utilised social media platforms to solicit donations from wider networks, though this approach was not universally successful. A 35-year-old female patient with thyroid cancer explained: “I posted my story on Facebook and WhatsApp, asking for help. Some people I didn’t even know sent money. It wasn’t a lot, but every little bit helped.” While social support networks were essential facilitators, they were also insufficient and unsustainable. Reliance on informal support created several problems. Repeated health crises or chronic conditions have depleted social support networks. A 56-year-old male patient with thyroid cancer recurrence expressed his shame: “This is my second time needing treatment. The first time, people helped me. But now, I feel ashamed to ask again. People are tired of always helping. Everyone has their own problems.” Patients with weak social networks, including those who were socially isolated, had migrated from their home communities, or came from poor families, lacked this crucial support. A 39-year-old female patient stated simply, “I don’t have family here. My parents are dead, and I don’t have siblings. I am managing on my own. It’s very difficult.” Mobilising support from extended family and community members, who were often themselves economically vulnerable, spread financial hardship across social networks. A social worker observed: “We see the burden that falls on families. Sometimes the whole family is impoverished, trying to save one member. It’s not sustainable. We need a proper health financing system.” Additional Findings: Systemic and Institutional Barriers Beyond the three major themes, participants identified several systemic and institutional barriers. The frequent unavailability of radiopharmaceuticals and equipment downtime disrupted service delivery, forcing patients to wait for extended periods or seek services elsewhere. A 50-year-old male patient from Calabar described his frustration: “I came all the way from Calabar, and when I got here, they said the machine is not working. I had to wait for two weeks. I had nowhere to stay, no money for hotel. It was terrible.” Healthcare providers attributed these challenges to supply chain vulnerabilities and inadequate funding for equipment maintenance. A radiographer explained: “We depend on imported radiopharmaceuticals. Sometimes there are delays in supply, and we can’t do anything. Patients suffer because these are systemic problems beyond our control.” Many patients reported a lack of information about nuclear medicine services, referral processes, and what to expect during treatment. A 41-year-old female patient expressed her confusion: “Nobody explained to me what nuclear medicine is or why I need it. I was just told to come to Ibadan. I was confused and afraid.” Improving patient education and physician communication was identified as an important area for intervention. Discussion This study offers critical, patient-centred insights into the barriers and facilitators that shape access to nuclear medicine services in Nigeria. The findings reveal a complex interplay of financial, geographic, and systemic factors that create profound inequities in healthcare access. Situated within Weber’s Social Action Theory, patient decisions to seek nuclear medicine services represent instrumental-rational actions aimed at achieving health goals; however, these actions are severely constrained by structural barriers and are enabled primarily through informal social support mechanisms. The financial barriers documented in this study align with broader literature on healthcare financing challenges in low- and middle-income countries [ 35 , 36 ]. The catastrophic costs of nuclear medicine services, ranging from ₦80,000 to ₦750,000 for radioiodine therapy alone, far exceed the annual income of most Nigerian households, where the minimum wage is ₦30,000 per month, approximately $ 72 USD. When indirect costs, including transportation, accommodation, and income loss, are factored in, total expenditures can exceed ₦1,000,000, equivalent to $ 2,400 USD, representing multiple years of income for average families. These findings resonate with the global literature on financial toxicity of cancer care [ 37 , 38 ]. A systematic review by Carrera and colleagues found that out-of-pocket payments for cancer treatment in low- and middle-income countries often exceed 40% of annual household income, leading to catastrophic expenditure and impoverishment [ 38 ]. In Nigeria’s context, where health insurance coverage is minimal and excludes advanced diagnostics and therapeutics, patients bear the full financial burden. The coping strategies employed by patients, including asset depletion, borrowing, and treatment abandonment, mirror patterns documented in other African contexts [ 39 , 40 ]. These strategies, while enabling short-term access, have long-term consequences, including household impoverishment, indebtedness, and compromised health outcomes when treatment is delayed or abandoned. The absence of insurance coverage for nuclear medicine services represents a critical policy failure. International evidence demonstrates that expanding insurance coverage for cancer care improves access, reduces financial toxicity, and enhances health outcomes [ 41 ]. Nigeria’s recent efforts to achieve universal health coverage must prioritize inclusion of advanced diagnostics and therapeutics in benefit packages. Geographic barriers in this study reflect the skewed distribution of specialised healthcare services in Nigeria. Patients travelling over 1,000 kilometres for treatment face not only financial costs but also physical discomfort, time away from family and livelihoods, and safety risks. This finding aligns with Otu’s documentation of geographic inequities in Nigerian healthcare and broader literature on distance as a barrier to healthcare access in Africa [ 28 , 42 , 43 ]. The concept of effective access, defined as the ability to reach services within an acceptable timeframe and at a reasonable cost, is clearly violated for most nuclear medicine patients in Nigeria [ 12 ]. While UCH, Ibadan, provides high-quality services, the concentration of services in one or two centres nationally creates insurmountable barriers for geographically distant populations. International evidence supports decentralisation of specialised services to improve equity [ 44 , 45 ]. However, nuclear medicine presents unique challenges due to the capital intensity of equipment, workforce requirements, and radiopharmaceutical supply chains. Taiwo and Orunmuyi’s geospatial analysis proposed optimal locations for nuclear medicine clinics in Nigeria to maximise population coverage while maintaining service viability [ 4 ]. Implementing evidence-based geographic planning, coupled with investments in infrastructure and the workforce, could significantly improve accessibility. Telemedicine and tele-reporting models, successfully implemented in other resource-limited settings [ 46 ], offer potential solutions for extending nuclear medicine expertise to peripheral centres. Remote consultation, image interpretation, and patient education could reduce the need for long-distance travel while maintaining the quality of care. The critical role of social support networks in facilitating healthcare access is well-documented in African contexts [ 47 , 48 ]. This study’s findings demonstrate that extended family systems, religious organisations, and community associations function as informal safety nets, mobilising financial, emotional, and practical support for patients. From a Weberian perspective, the mobilisation of social support represents value-rational and affectual social action, motivated by familial obligations, religious values, and emotional bonds rather than purely instrumental calculations. These social solidarity mechanisms reflect deep-rooted cultural values and have historically served as coping mechanisms in contexts of limited state welfare provision [ 49 ]. However, this study also highlights the limitations and inequities associated with relying on informal support. Patients with weak social networks face significant disadvantages, resulting in a form of social capital inequality in healthcare access [ 50 ]. Moreover, the exhaustion of social support networks through repeated health crises and the spreading of financial burden across economically vulnerable families perpetuate cycles of poverty. The dual nature of social support, as both a facilitator and an indicator of system failure, has significant policy implications. While community-based health financing schemes and social health insurance can build on existing solidarity mechanisms [ 51 ], they must be formalised, universal, and adequately funded to provide sustainable and equitable protection. International evidence demonstrates that countries transitioning from informal to formal health financing systems can improve equity and financial protection [ 52 ]. The systemic barriers identified, including radiopharmaceutical supply disruptions, equipment downtime, and information gaps, reflect broader challenges in Nigeria’s health system, including inadequate funding, supply chain vulnerabilities, and weak health information systems [ 53 ]. These findings align with international literature on nuclear medicine in low- and middle-income countries, which identifies infrastructure, workforce, regulatory, and supply chain challenges as significant constraints [ 15 , 17 , 24 ]. Addressing these systemic challenges requires multi-level interventions including infrastructure investment through upgrading and expanding nuclear medicine facilities with strategic geographic distribution, workforce development through training nuclear medicine physicians, medical physicists, radiopharmacists, and technicians, supply chain strengthening through local radiopharmaceutical production, diversification of suppliers, and regional collaboration, regulatory harmonization through streamlining regulatory frameworks to reduce operational costs while maintaining safety standards, and health information systems improvement through better patient education, referral systems, and communication. The barriers documented in this study have profound implications for health equity. Nuclear medicine services, essential for diagnosing and treating cancer and other non-communicable diseases, are effectively inaccessible to most Nigerians due to financial and geographic constraints. This creates a two-tiered system where wealthier urban populations can access advanced care while poorer and rural populations are excluded, perpetuating health inequities. The social determinants of health framework emphasizes that health inequities arise from unequal distribution of resources, power, and opportunities [ 54 ]. In Nigeria’s context, inequitable access to nuclear medicine reflects broader structural inequalities, including poverty, geographic marginalisation, and inadequate public health financing. Addressing these inequities requires not only health sector interventions but also wider social and economic policies aimed at reducing poverty and regional disparities. This study has several strengths, including its patient-centred approach that prioritises patient voices and experiences, addressing a gap in predominantly biomedical nuclear medicine literature. The use of Weber’s Social Action Theory provides analytical depth and connects individual experiences to broader social structures. Multiple data sources, including patient, provider, and administrative data, along with systematic qualitative analysis, enhance credibility. The findings directly inform actionable policy recommendations. However, the study also has limitations. As a single-site study conducted at a single facility, the findings may not fully represent the experiences of other nuclear medicine centres in Nigeria. A cross-sectional design captures experiences at a single point in time, whereas longitudinal research can reveal how barriers evolve over the course of treatment trajectories. Selection bias exists as participants were patients who successfully accessed services, while those unable to access services are not represented. The findings are specific to Nigeria’s context, and transferability to other countries requires careful consideration of contextual differences. Conclusion This study reveals that financial barriers, geographic distance, and systemic healthcare challenges significantly restrict patient access to nuclear medicine services in Nigeria. While social support networks serve as critical facilitators, they are insufficient and inequitable, reflecting the absence of adequate formal health financing mechanisms. The findings underscore the urgent need for comprehensive policy interventions to improve equitable access to essential healthcare services. From a social science perspective, this research illustrates how structural inequalities, whether economic, geographic, or institutional shape individual health outcomes. Addressing these inequalities requires transformative changes in healthcare financing, service organisation, and health system governance. Based on the study findings, we propose several evidence-based policy recommendations. First, expanding health insurance coverage is essential. Nuclear medicine services must be included in the National Health Insurance Scheme benefit package, covering both diagnostic and therapeutic procedures. Implementing risk-pooling mechanisms would make advanced cancer care affordable, while providing subsidies for low-income patients would ensure equity. Developing partnerships between the government, the private sector, and development partners could finance expanded coverage. Second, expanding access to nuclear medicine services would significantly improve access. Establishing regional nuclear medicine centres in Nigeria’s six geopolitical zones would reduce travel distances. Using geospatial planning tools to optimise facility locations for maximum population coverage, investing in infrastructure and equipment at strategically located tertiary hospitals, and implementing telemedicine and tele-reporting to extend specialist expertise to peripheral centres would all contribute to improved geographic accessibility. Third, strengthening healthcare financing requires increasing public health expenditure to meet the Abuja Declaration target of 15% of government budgets. Establishing a dedicated cancer care fund to support infrastructure, workforce, and patient subsidies, and exploring innovative financing mechanisms, including sin taxes, donor funding, and public-private partnerships, would provide sustainable funding. Fourth, addressing supply chain challenges by supporting local radiopharmaceutical production would reduce dependence on imports and associated costs. Diversifying suppliers would minimise supply disruptions, while strengthening regional collaboration through the International Atomic Energy Agency and African regional bodies would facilitate technology transfer and supply chain coordination. Fifth, investing in workforce development through expanding training programs for nuclear medicine specialists, medical physicists, and radiopharmacists is crucial. Providing scholarships and incentives to attract and retain skilled professionals, and implementing task-shifting strategies where appropriate, would optimise workforce utilisation. Sixth, improving patient information and support through developing patient education materials about nuclear medicine services, referral processes, and what to expect would reduce anxiety and improve treatment adherence. Establishing patient navigation programs to guide patients through the healthcare system and creating support groups to provide peer support and information sharing would enhance patient experiences. Finally, conducting implementation research to pilot-test interventions in different contexts before scale-up, evaluating the effectiveness and cost-effectiveness of various service delivery models, and engaging communities in designing and implementing interventions would ensure cultural appropriateness and sustainability. This study opens several avenues for future research, including comparative studies across multiple nuclear medicine centers in Nigeria and other African countries, longitudinal research tracking patient experiences and outcomes over time, economic evaluations of different financing and service delivery models, implementation research testing interventions to improve accessibility, and studies of patients unable to access services to understand the full extent of unmet need. Achieving equitable access to nuclear medicine services in Nigeria is both a moral imperative and a public health necessity. As the burden of cancer and non-communicable diseases continues to rise, ensuring that all Nigerians can access essential diagnostic and therapeutic services is critical for improving health outcomes and achieving universal health coverage. This requires political will, sustained investment, and multi-sectoral collaboration. The voices of patients documented in this study underscore the human cost of healthcare inequities and the urgency of action. List of Abbreviations UCH University College Hospital PET-CT Positron Emission Tomography- Computed Tomography PET Positron Emission Tomography Declarations Ethics approval and consent to participate Ethics approval for this research was obtained from the University of Ibadan/University College Hospital Institutional Review Board. Administrative from the Department of Nuclear Medicine, University College Hospital Ibadan. In addition, informed consent was obtained from all the participants, and they gave verbal consent to participate in the research before interviews were conducted. The researcher adhered to all the ethical principles as stipulated by the National Health Research Ethics Code (NHREC). Consent for publication Not applicable Competing interests Authors declare no conflict of interest. Funding This study declare that no funding was received from any organization or individual Author Contribution AOA: Conceptualization, methodology, data collection, data analysis, writing—original draft. AO: Conceptualization, supervision, writing—review and editing. ASJ: Conceptualization, supervision, writing—review and editing. Acknowledgements The authors thank all patients, healthcare providers, and administrators who participated in this study. We acknowledge the support of the University College Hospital, Ibadan, and the Department of Sociology, University of Ibadan. Data Availability The qualitative data supporting this study’s findings are available from the corresponding author upon reasonable request, subject to ethical approval and participant consent provisions. References World Health Organization. Noncommunicable Diseases Country Profiles 2018: Nigeria. Geneva: WHO; 2018. Ayandipo OO, Orunmuyi AT, Akande TO, Ogun OA. 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Progress on catastrophic health spending in 133 countries: a retrospective observational study. Lancet Glob Health. 2018;6(2):e169–79. 10.1016/S2214-109X(17)30429-1 . Zafar SY, Abernethy AP. Financial toxicity, part I: a new name for a growing problem. Oncology. 2013;27(2):80–1. Carrera PM, Kantarjian HM, Blinder VS. The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin. 2018;68(2):153–65. 10.3322/caac.21443 . Kankeu HT, Saksena P, Xu K, Evans DB. The financial burden from non-communicable diseases in low- and middle-income countries: a literature review. Health Res Policy Syst. 2013;11:31. 10.1186/1478-4505-11-31 . Alam K, Mahal A. Economic impacts of health shocks on households in low and middle income countries: a review of the literature. Global Health. 2014;10:21. 10.1186/1744-8603-10-21 . Dmytraczenko T, Almeida G, editors. Toward Universal Health Coverage and Equity in Latin America and the Caribbean: Evidence from Selected Countries. Washington, DC: World Bank; 2015. Kelly C, Hulme C, Farragher T, Clarke G. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review. BMJ Open. 2016;6(11):e013059. 10.1136/bmjopen-2016-013059 . Tanser F, Gijsbertsen B, Herbst K. Modelling and understanding primary health care accessibility and utilization in rural South Africa: an exploration using a geographical information system. Soc Sci Med. 2006;63(3):691–705. Atun R, de Andrade LO, Almeida G, et al. Health-system reform and universal health coverage in Latin America. Lancet. 2015;385(9974):1230–47. 10.1016/S0140-6736(14)61646-9 . Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–252. 10.1016/S2214-109X(18)30386-3 . Paez D, Orellana P, Soza-Ried C, et al. Telemedicine and nuclear medicine: a successful model for remote reporting and interpretation in Chile. Semin Nucl Med. 2020;50(4):313–9. Gyasi RM, Phillips DR, Amoako EPA. Multidimensional social support and health services utilization among noninstitutionalized older persons in Ghana. J Aging Health. 2020;32(5–6):227–39. 10.1177/0898264318816217 . Mwai GW, Mburu G, Torpey K, et al. Role and outcomes of community health workers in HIV care in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013;16:18586. 10.7448/IAS.16.1.18586 . Olivier de Sardan JP. The delivery state in Africa: interface bureaucrats, professional cultures and the bureaucratic mode of governance. In: Bierschenk T, de Olivier JP, editors. States at Work: Dynamics of African Bureaucracies. Leiden: Brill; 2014. pp. 399–429. Kawachi I, Subramanian SV, Kim D, editors. Social Capital and Health. New York: Springer; 2008. Mladovsky P, Mossialos E. A conceptual framework for community-based health insurance in low-income countries: social capital and economic development. World Dev. 2008;36(4):590–607. 10.1016/j.worlddev.2007.04.018 . Kutzin J. Health financing for universal coverage and health system performance: concepts and implications for policy. Bull World Health Organ. 2013;91(8):602–11. 10.2471/BLT.12.113985 . Uzochukwu BSC, Ughasoro MD, Etiaba E, et al. Health care financing in Nigeria: implications for achieving universal health coverage. Niger J Clin Pract. 2015;18(4):437–44. 10.4103/1119-3077.154196 . Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9. 10.1016/S0140-6736(08)61690-6 . Additional Declarations No competing interests reported. Supplementary Files Interviewguides.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 29 Mar, 2026 Editor assigned by journal 25 Mar, 2026 Editor invited by journal 23 Mar, 2026 Submission checks completed at journal 21 Mar, 2026 First submitted to journal 21 Mar, 2026 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-8986443","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":613987396,"identity":"ab2acbe7-0330-495a-a188-69c6367393e8","order_by":0,"name":"Aderonke Omotayo Aliu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIiWNgGAWjYFCCBDYIfQBC8PAzMLCRpkVGsoFULTYGBwho4W9PPvbgZ5uNPN/x3oePC87Y8BjfSH724EMFgzy/2AGsWiTOPEs37G1LM5x55rix8YwbaTxmN9LMDWecYTCcOTsBuzU3cswkeNsOM264kcYmzfPhMFBLgpk0bxtDgsFt7Frkb+R/k/zbdth+w/1nIC3/eYxnpH/Dq8XgRg4bUMHhxA032IBabhzgMZDIwW+L4Zln5sYy59KSZ55JYzbmOZPMI3HmTZnkjDMSOP0idzz52cM3ZTa2fcePMT7mOWZnz9+evk3iQ4WNPL80Du+DACNKRAiAVUrgVg4Gf5A5/AcIqB4Fo2AUjIKRBgCt4mPBCMLZHgAAAABJRU5ErkJggg==","orcid":"","institution":"University of Ibadan","correspondingAuthor":true,"prefix":"","firstName":"Aderonke","middleName":"Omotayo","lastName":"Aliu","suffix":""},{"id":613987397,"identity":"a9228f92-6e80-4da7-9dcc-fc648a8ad5c7","order_by":1,"name":"Akintunde Orunmuyi","email":"","orcid":"","institution":"University College Hospital, Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Akintunde","middleName":"","lastName":"Orunmuyi","suffix":""},{"id":613987398,"identity":"cf7d8ae6-d31d-45cd-85ac-0bdb714a44ce","order_by":2,"name":"Ayodele Samuel Jegede","email":"","orcid":"","institution":"University of Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Ayodele","middleName":"Samuel","lastName":"Jegede","suffix":""}],"badges":[],"createdAt":"2026-02-27 09:54:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8986443/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8986443/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106034249,"identity":"fc6c332f-cbaf-4d94-997d-940f608a8a95","added_by":"auto","created_at":"2026-04-02 15:56:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":610015,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8986443/v1/5d73cb55-a7c4-4573-a260-9d35fe2dbcb6.pdf"},{"id":106034178,"identity":"54f07dfe-d8b1-45c6-ad36-1373bac3d5f9","added_by":"auto","created_at":"2026-04-02 15:56:19","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":23218,"visible":true,"origin":"","legend":"","description":"","filename":"Interviewguides.docx","url":"https://assets-eu.researchsquare.com/files/rs-8986443/v1/07bb82f686164dd01278a0b8.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Barriers and Facilitators to Patient Accessibility of Nuclear Medicine Services in Nigeria: A Social Science Perspective","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNuclear medicine plays an indispensable role in the diagnosis and treatment of cancer and non-communicable diseases, which are increasingly being recognised as major public health challenges in low- and middle-income countries. In Nigeria, non-communicable diseases account for approximately 29% of all deaths, with cancer representing a significant and growing burden [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Nuclear medicine techniques, particularly radioiodine therapy for thyroid cancer and diagnostic imaging using radiopharmaceuticals, offer critical therapeutic and diagnostic capabilities that are often unavailable through conventional medical approaches [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these benefits, access to nuclear medicine services in sub-Saharan Africa remains severely limited. The World Health Organisation estimates that over 90% of the global population in low- and middle-income countries lacks adequate access to essential diagnostic imaging, including nuclear medicine [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In Nigeria, nuclear medicine services are only available at two tertiary and other private hospitals located in major urban centres, creating significant geographic and socioeconomic barriers for patients requiring these specialised services [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile existing literature on nuclear medicine in Nigeria has predominantly focused on clinical outcomes, technical challenges, and awareness among healthcare providers [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], there is a notable absence of patient-centred research examining the social, economic, and structural factors that shape access to these services. Previous studies by Alonge and Okoje demonstrated high awareness of nuclear medicine among Nigerian medical practitioners. However, Orunmuyi and colleagues reported surprising underutilization of these services [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This paradox suggests that factors beyond clinical awareness, including patient-level barriers and systemic healthcare challenges, significantly influence accessibility.\u003c/p\u003e \u003cp\u003eThe social science perspective offers valuable insights into understanding healthcare accessibility as a multidimensional phenomenon shaped by individual agency, social structures, economic constraints, and institutional arrangements [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. By examining patient experiences and the social context of healthcare seeking, this study addresses a critical gap in understanding how Nigerians navigate access to nuclear medicine services.\u003c/p\u003e \u003cp\u003eThis study is grounded in Max Weber\u0026rsquo;s Social Action Theory, which emphasises understanding human behaviour through the meanings and motivations individuals attach to their actions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Weber identified four types of social action: instrumental-rational action, oriented toward achieving specific goals; value-rational action, guided by ethical or religious values; affectual action, driven by emotions; and traditional action, based on customs and habits. In the context of healthcare seeking, patients\u0026rsquo; decisions to access nuclear medicine services can be understood as instrumental-rational actions aimed at achieving health goals. Still, these actions are constrained and facilitated by social, economic, and structural factors. This theoretical lens allows us to examine how patients make decisions about seeking nuclear medicine services, how they mobilise resources through social networks, and how structural barriers shape their healthcare experiences.\u003c/p\u003e \u003cp\u003eThis study aimed to identify and analyse the barriers that impede patient accessibility to nuclear medicine services at UCH, Ibadan, to examine the facilitators that enable patients to overcome these barriers, to explore the role of social support networks in healthcare access, and to provide evidence-based recommendations for policy and practice to improve equitable access to nuclear medicine services in Nigeria.\u003c/p\u003e \u003cp\u003eHealthcare accessibility is a complex, multidimensional construct that extends beyond mere physical availability of services. Levesque and colleagues conceptualised access as occurring at the interface between health systems and populations, encompassing five dimensions: approachability, acceptability, availability and accommodation, affordability, and appropriateness [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This framework recognises that access is determined not only by supply-side factors such as healthcare system characteristics but also by demand-side factors, including population characteristics and capabilities. Penchansky and Thomas earlier proposed five dimensions of access: availability, accessibility, accommodation, affordability, and acceptability [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Saurma later modified this framework to reflect contemporary healthcare challenges better, emphasising the dynamic interaction between healthcare systems and patient populations [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These frameworks emphasise that improving access necessitates addressing multiple barriers simultaneously across various system levels.\u003c/p\u003e \u003cp\u003eNuclear medicine services in developing countries face distinctive challenges related to infrastructure, workforce, regulatory frameworks, and supply chains [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The International Atomic Energy Agency has documented persistent gaps in nuclear medicine capacity across Africa, with most countries having fewer than one nuclear medicine facility per 10\u0026nbsp;million population [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Recent studies have identified several critical barriers that constrain service delivery and patient access.\u003c/p\u003e \u003cp\u003eInfrastructure and equipment limitations represent a fundamental challenge. The limited availability of gamma cameras, PET-CT scanners, and radiopharmaceutical production facilities constrains service delivery [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Capital-intensive equipment requirements and dependence on imported technology create sustainability challenges [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Workforce shortages further exacerbate these problems, as the insufficient number of trained nuclear medicine physicians, medical physicists, and radiopharmacists limits service capacity [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Brain drain and limited training opportunities exacerbate workforce gaps [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSupply chain vulnerabilities pose another significant barrier. Dependence on single suppliers for radiopharmaceuticals and radionuclide generators can lead to supply disruptions [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The short half-life of many radiopharmaceuticals necessitates reliable and timely delivery systems, which are often lacking in resource-limited settings [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Regulatory complexity and institutional incoherence increase operational costs and threaten service sustainability [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. High out-of-pocket costs for patients, combined with limited insurance coverage for specialised diagnostic and therapeutic services, create significant affordability barriers [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNigeria\u0026rsquo;s healthcare system is not unfamiliar with significant inequities in access, quality, and outcomes [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Geographic disparities are pronounced, with advanced medical services concentrated in urban tertiary hospitals while rural populations face substantial distance and transportation barriers [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Otu documented that many Nigerians must travel over 100 kilometres to access specialised healthcare services, incurring significant time and financial costs [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Financial barriers are particularly acute in Nigeria\u0026rsquo;s predominantly out-of-pocket healthcare financing system. The National Health Insurance Scheme covers less than 5% of the population, and even among the insured, coverage for advanced diagnostics and cancer treatment is limited [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Catastrophic health expenditure, defined as health spending exceeding 40% of household capacity to pay, is common among Nigerian families seeking care for serious illnesses [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSocial support networks play a crucial role in healthcare access in Nigeria. Extended family systems, community associations, and religious organisations often mobilise resources to support individuals facing health crises [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. However, reliance on informal support mechanisms is both a facilitator and an indicator of systemic failures in healthcare financing [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This study addresses a critical evidence gap by providing patient-centered insights into accessibility barriers and facilitators for nuclear medicine services in Nigeria.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eThis study employed a qualitative descriptive cross-sectional design to explore patient experiences and perspectives on accessing nuclear medicine services. Qualitative methods are particularly suited to understanding complex social phenomena, capturing the meanings individuals attach to their experiences, and identifying contextual factors that shape health behaviours [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The research was conducted at the University College Hospital (UCH), Ibadan, one of Nigeria\u0026rsquo;s premier tertiary healthcare institutions and a leading centre for nuclear medicine services. UCH\u0026rsquo;s Nuclear Medicine Department provides diagnostic and therapeutic services, including radioiodine therapy for thyroid disorders, bone scans, renal studies, and other specialised procedures. As one of the few functional nuclear medicine centers in Nigeria, UCH serves patients from across the country, making it an ideal setting for examining accessibility challenges.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population and participants\u003c/h3\u003e\n\u003cp\u003eThe study population comprised three groups: patients who had accessed or were accessing nuclear medicine services at UCH, healthcare providers including nuclear medicine physicians, radiographers, and nurses, and hospital administrators involved in service delivery and administration. Purposive sampling was used to select information-rich cases that could provide in-depth insights into accessibility issues. Patients were selected to ensure diversity in terms of type of nuclear medicine service accessed, geographic origin, socioeconomic background, gender and age. Healthcare providers and administrators were selected based on their roles and experience in nuclear medicine service delivery. Data collection continued until thematic saturation was achieved, resulting in 36 in-depth interviews with patients, 16 case studies of patient journeys, and 11 key informant interviews with healthcare providers and administrators.\u003c/p\u003e \u003cp\u003eSemi-structured interviews were conducted with patients to explore their experiences accessing nuclear medicine services. Interview guides covered topics including pathways to UCH and referral processes, financial costs and coping strategies, transportation and accommodation challenges, social support mobilisation, perceptions of service quality and availability, and suggestions for improving accessibility. Detailed case studies documented patient journeys from initial diagnosis through treatment completion, capturing the full spectrum of challenges encountered and strategies employed to overcome barriers. Interviews with healthcare providers and administrators explored operational challenges in service delivery, patient obstacles, institutional constraints and facilitators, and policy perspectives on improving accessibility.\u003c/p\u003e \u003cp\u003e Interviews were conducted in either English or Yoruba, the predominant local language, at the participant's preference. All interviews were audio-recorded with participant consent and transcribed verbatim. Yoruba interviews were translated into English by bilingual research assistants, with back-translation checks to ensure accuracy. Interviews lasted between 45 and 90 minutes and were conducted in private settings within the hospital to ensure confidentiality. Field notes were taken during and after interviews to capture non-verbal cues and contextual observations.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData was analyzed using thematic analysis, following Braun and Clarke\u0026rsquo;s six-phase framework [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The process involved familiarisation with data through repeated reading of transcripts, generating initial codes systematically across the dataset, searching for themes by collating codes into potential themes, reviewing themes to ensure they work in relation to coded extracts and the entire dataset, defining and naming themes, and producing the final report with vivid examples. MaxQDA software was used to facilitate data management, coding, and theme development. The analytical process was iterative, with constant comparison between emerging themes and raw data to ensure interpretations were grounded in participant accounts.\u003c/p\u003e \u003cp\u003eEthical approval was obtained from the University of Ibadan/University College Hospital Institutional Review Board. All participants provided written informed consent after receiving detailed information about the study\u0026rsquo;s purpose, procedures, risks, and benefits. Participation was voluntary, and participants were informed of their right to withdraw at any time without consequences. Confidentiality was maintained through the use of pseudonyms in transcripts and reports, secure data storage, and restricted access to the research team. Given the sensitive nature of discussing financial challenges and health conditions, interviews were conducted with empathy and cultural sensitivity.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eSeveral strategies were employed to enhance the trustworthiness of the findings. Credibility was ensured through prolonged field engagement, triangulation of data sources (including patients, providers, and administrators), and member checking with selected participants. Transferability was supported by a detailed description of the context, participants, and findings, enabling readers to assess the applicability to other settings. Dependability was maintained through an audit trail of analytical decisions and systematic coding procedures. Confirmability was achieved through reflexivity regarding researchers\u0026rsquo; positionality and potential biases.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThree major themes emerged from the data analysis: financial barriers and coping strategies, geographic accessibility challenges, and social support networks as facilitators. Each theme is presented below, accompanied by illustrative quotations.\u003c/p\u003e\n\u003ch3\u003eFinancial Barriers and Coping Strategies\u003c/h3\u003e\n\u003cp\u003eFinancial constraints emerged as the most significant barrier to accessing nuclear medicine services. Participants described multiple layers of costs that extended far beyond the direct medical expenses. The cost of radioiodine therapy ranged from ₦80,000 (\u003cspan\u003e$\u003c/span\u003e200) to ₦750,000 (\u003cspan\u003e$\u003c/span\u003e1,800 USD), based on the exchange rates at the time of the study.\u003c/p\u003e \u003cp\u003eOne patient, a 45-year-old female teacher with thyroid cancer, expressed her shock at the treatment costs: \u0026ldquo;When they told me the cost of the treatment, I was shocked. ₦500,000 for just the capsule! Where will I get that kind of money? I am a teacher, my salary is ₦70,000 per month. Even if I save everything for a year without eating, it won\u0026rsquo;t be enough.\u0026rdquo; Diagnostic procedures, while less expensive than therapeutic interventions, still imposed significant financial burdens. A 58-year-old male patient with prostate cancer explained: \u0026ldquo;The bone scan cost ₦35,000 (\u003cspan\u003e$\u003c/span\u003e88), then they said I need another test, another ₦40,000 (\u003cspan\u003e$\u003c/span\u003e100). Every time I come, there is another bill. I have spent over ₦200,000 on tests alone, and they haven\u0026rsquo;t even started the main treatment.\u0026rdquo;\u003c/p\u003e \u003cp\u003eBeyond direct medical expenses, patients incurred substantial indirect costs, including transportation, accommodation, and subsistence expenses. Many patients travelled from distant states and required extended stays in Ibadan for treatment and follow-up. A 52-year-old male patient from Maiduguri described his experience: \u0026ldquo;I came from Maiduguri. The transport alone cost ₦25,000 (\u003cspan\u003e$\u003c/span\u003e63) one way. I had to stay in Ibadan for three weeks because of the isolation period after the treatment. Accommodation was ₦2,000 (\u003cspan\u003e$\u003c/span\u003e5) per night, then food every day, and it all adds up. In total, apart from the treatment itself, I spent almost ₦150,000 (\u003cspan\u003e$\u003c/span\u003e375) on these other things.\u0026rdquo; For patients from rural areas, the need to stay in urban accommodation represents a significant financial and social burden, separating them from family support systems and income-generating activities.\u003c/p\u003e \u003cp\u003eMany patients experienced income loss due to extended absences from work during treatment and recovery periods. A 41-year-old self-employed female patient explained: \u0026ldquo;I am self-employed, I have a small shop. When I came here for treatment, I had to close the shop for one month. No sales, no income, but the expenses kept coming. My business suffered seriously.\u0026rdquo;\u003c/p\u003e \u003cp\u003eFaced with overwhelming costs, patients employed various coping strategies, most of which had long-term negative consequences. Many patients exhausted their life savings or sold assets such as land, vehicles, or jewelry to finance treatment. A 60-year-old male patient with thyroid cancer stated: \u0026ldquo;I sold my car and a plot of land I was keeping for my children\u0026rsquo;s future. What choice did I have? It\u0026rsquo;s life or death.\u0026rdquo; Patients commonly borrowed money from family members, friends, or informal lenders, often at high interest rates, creating long-term debt burdens. A 48-year-old female patient explained: \u0026ldquo;I borrowed from everywhere\u0026mdash;family, friends, even my cooperative society. Now I am in serious debt. I don\u0026rsquo;t know how I will pay back all this money.\u0026rdquo;\u003c/p\u003e \u003cp\u003eSome patients delayed treatment while attempting to raise funds, potentially compromising health outcomes. Others abandoned treatment entirely when financial resources were exhausted. A 55-year-old male patient admitted: \u0026ldquo;I was supposed to come back for follow-up three months ago, but I couldn\u0026rsquo;t afford the transport and the tests. I\u0026rsquo;m just managing at home and praying.\u0026rdquo; A nuclear medicine physician confirmed this pattern: \u0026ldquo;We see patients who start treatment and then disappear because they can\u0026rsquo;t afford to continue. It\u0026rsquo;s heartbreaking because we know their condition may deteriorate without completing the treatment.\u0026rdquo;\u003c/p\u003e \u003cp\u003eThe absence of insurance coverage for nuclear medicine services exacerbates the financial barriers. Even patients enrolled in the National Health Insurance Scheme found that their coverage excluded advanced diagnostic and therapeutic procedures. A 51-year-old male patient expressed his frustration: \u0026ldquo;I have health insurance from my work, but when I asked, they said nuclear medicine is not covered. So what is the point of having insurance if it doesn\u0026rsquo;t cover when you really need it?\u0026rdquo; A hospital administrator explained: \u0026ldquo;The insurance schemes in Nigeria have minimal coverage. They cover basic things like consultation and common drugs, but not expensive procedures like radioiodine therapy or PET scans. So patients still have to pay out of pocket for these services.\u0026rdquo;\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eGeographic Accessibility Challenges\u003c/h2\u003e \u003cp\u003eGeographic barriers emerged as a significant constraint, reflecting the skewed distribution of nuclear medicine services in Nigeria. Patients traveled from all regions of Nigeria to access services at UCH, Ibadan. Travel distances ranged from 50 kilometres for patients within Oyo State to over 1,000 kilometres for those from distant states. A 49-year-old male patient from Sokoto described his journey: \u0026ldquo;I travelled from Sokoto; it took me two days by road. The journey itself was exhausting, and I was already weak from my illness. But there is no nuclear medicine in Sokoto, so I had no choice.\u0026rdquo;\u003c/p\u003e \u003cp\u003eThe concentration of services in a few urban centres meant that patients in rural and remote areas faced particularly severe challenges to accessibility. Long-distance travel posed multiple challenges including high costs, physical discomfort for ill patients, and safety concerns, particularly given Nigeria\u0026rsquo;s security situation in some regions. A 44-year-old female patient expressed her fears: \u0026ldquo;The roads are bad, and there is insecurity in some areas. I was afraid to travel, but I had to. The bus was uncomfortable, and by the time I reached Ibadan, I was in so much pain.\u0026rdquo; For patients requiring multiple visits for treatment and follow-up, repeated long-distance travel multiplied these challenges.\u003c/p\u003e \u003cp\u003ePatients from distant locations required accommodation in Ibadan, often for extended periods. Finding affordable and safe accommodation near the hospital was challenging, particularly for patients with limited financial resources. A 38-year-old female patient explained, \u0026ldquo;I didn\u0026rsquo;t know anyone in Ibadan. I had to look for a place to stay. The hotels near the hospital are expensive. I found a small room in a local area, but it was not comfortable and quite far from the hospital.\u0026rdquo; Some patients stayed with relatives or friends in Ibadan, but this option was not available to everyone and sometimes created social obligations and discomfort.\u003c/p\u003e \u003cp\u003eGeographic distance affected not only patients but also family members who served as caregivers. Family members often had to choose between accompanying patients, incurring additional costs and time away from home, or remaining behind, leaving patients without adequate support. A 47-year-old male patient with thyroid cancer reflected: \u0026ldquo;My wife wanted to come with me, but we have young children at home. She couldn\u0026rsquo;t leave them for weeks. So I came alone. It was lonely and difficult, especially during the isolation period after treatment.\u0026rdquo;\u003c/p\u003e \u003cp\u003eHealthcare providers recognised that geographic barriers contributed to late presentation, treatment delays, and poor follow-up compliance. A nuclear medicine physician observed: \u0026ldquo;Many patients come to us very late because they have been trying other treatments closer to home. By the time they reach us, the disease is advanced. And then after treatment, follow-up is poor because they live so far away.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSocial Support Networks as Facilitators\u003c/h3\u003e\n\u003cp\u003eDespite overwhelming barriers, social support networks emerged as the primary facilitator enabling patients to access nuclear medicine services. These networks mobilised financial, emotional, and practical support. Extended family systems played a crucial role in pooling financial resources for treatment. A 43-year-old female patient with thyroid cancer described her family\u0026rsquo;s support: \u0026ldquo;My brothers and sisters contributed money. My uncle gave ₦100,000, (\u003cspan\u003e$\u003c/span\u003e250) my brother gave ₦80,000 (\u003cspan\u003e$\u003c/span\u003e200), and my sister sold some jewellery. Without my family, I could never have afforded this treatment.\u0026rdquo; Family support extended beyond finances to include emotional support, caregiving, and advocacy within the healthcare system. A 62-year-old female patient explained, \u0026ldquo;My son came with me and stayed throughout the treatment. He helped me communicate with the doctors, collected my medications, and took care of me. I don\u0026rsquo;t know what I would have done without him.\u0026rdquo;\u003c/p\u003e \u003cp\u003eCommunity associations, religious congregations, and social groups mobilised collective support for members facing health crises. A 54-year-old male patient with thyroid cancer shared: \u0026ldquo;My church organised a fundraiser for me. They announced my situation, and members contributed what they could. Some gave ₦5,000, while others gave ₦10,000. In the end, they raised ₦300,000 (\u003cspan\u003e$\u003c/span\u003e750) for me. I was so touched by their generosity.\u0026rdquo; These collective support mechanisms reflected strong social solidarity but also highlighted the absence of formal safety nets.\u003c/p\u003e \u003cp\u003eSome patients received financial assistance from employers or workplace cooperative societies. A 46-year-old female patient noted: \u0026ldquo;My office organised a contribution for me. My colleagues were very supportive. The cooperative society also gave me a loan at a low interest rate. That helped a lot.\u0026rdquo; However, this form of support was limited to formal sector employees, excluding most Nigerians working in the informal sector. A few younger patients utilised social media platforms to solicit donations from wider networks, though this approach was not universally successful. A 35-year-old female patient with thyroid cancer explained: \u0026ldquo;I posted my story on Facebook and WhatsApp, asking for help. Some people I didn\u0026rsquo;t even know sent money. It wasn\u0026rsquo;t a lot, but every little bit helped.\u0026rdquo;\u003c/p\u003e \u003cp\u003eWhile social support networks were essential facilitators, they were also insufficient and unsustainable. Reliance on informal support created several problems. Repeated health crises or chronic conditions have depleted social support networks. A 56-year-old male patient with thyroid cancer recurrence expressed his shame: \u0026ldquo;This is my second time needing treatment. The first time, people helped me. But now, I feel ashamed to ask again. People are tired of always helping. Everyone has their own problems.\u0026rdquo; Patients with weak social networks, including those who were socially isolated, had migrated from their home communities, or came from poor families, lacked this crucial support. A 39-year-old female patient stated simply, \u0026ldquo;I don\u0026rsquo;t have family here. My parents are dead, and I don\u0026rsquo;t have siblings. I am managing on my own. It\u0026rsquo;s very difficult.\u0026rdquo;\u003c/p\u003e \u003cp\u003eMobilising support from extended family and community members, who were often themselves economically vulnerable, spread financial hardship across social networks. A social worker observed: \u0026ldquo;We see the burden that falls on families. Sometimes the whole family is impoverished, trying to save one member. It\u0026rsquo;s not sustainable. We need a proper health financing system.\u0026rdquo;\u003c/p\u003e\n\u003ch3\u003eAdditional Findings: Systemic and Institutional Barriers\u003c/h3\u003e\n\u003cp\u003eBeyond the three major themes, participants identified several systemic and institutional barriers. The frequent unavailability of radiopharmaceuticals and equipment downtime disrupted service delivery, forcing patients to wait for extended periods or seek services elsewhere. A 50-year-old male patient from Calabar described his frustration: \u0026ldquo;I came all the way from Calabar, and when I got here, they said the machine is not working. I had to wait for two weeks. I had nowhere to stay, no money for hotel. It was terrible.\u0026rdquo; Healthcare providers attributed these challenges to supply chain vulnerabilities and inadequate funding for equipment maintenance. A radiographer explained: \u0026ldquo;We depend on imported radiopharmaceuticals. Sometimes there are delays in supply, and we can\u0026rsquo;t do anything. Patients suffer because these are systemic problems beyond our control.\u0026rdquo;\u003c/p\u003e \u003cp\u003eMany patients reported a lack of information about nuclear medicine services, referral processes, and what to expect during treatment. A 41-year-old female patient expressed her confusion: \u0026ldquo;Nobody explained to me what nuclear medicine is or why I need it. I was just told to come to Ibadan. I was confused and afraid.\u0026rdquo; Improving patient education and physician communication was identified as an important area for intervention.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study offers critical, patient-centred insights into the barriers and facilitators that shape access to nuclear medicine services in Nigeria. The findings reveal a complex interplay of financial, geographic, and systemic factors that create profound inequities in healthcare access. Situated within Weber\u0026rsquo;s Social Action Theory, patient decisions to seek nuclear medicine services represent instrumental-rational actions aimed at achieving health goals; however, these actions are severely constrained by structural barriers and are enabled primarily through informal social support mechanisms.\u003c/p\u003e \u003cp\u003eThe financial barriers documented in this study align with broader literature on healthcare financing challenges in low- and middle-income countries [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The catastrophic costs of nuclear medicine services, ranging from ₦80,000 to ₦750,000 for radioiodine therapy alone, far exceed the annual income of most Nigerian households, where the minimum wage is ₦30,000 per month, approximately \u003cspan\u003e$\u003c/span\u003e72 USD. When indirect costs, including transportation, accommodation, and income loss, are factored in, total expenditures can exceed ₦1,000,000, equivalent to \u003cspan\u003e$\u003c/span\u003e2,400 USD, representing multiple years of income for average families. These findings resonate with the global literature on financial toxicity of cancer care [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. A systematic review by Carrera and colleagues found that out-of-pocket payments for cancer treatment in low- and middle-income countries often exceed 40% of annual household income, leading to catastrophic expenditure and impoverishment [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In Nigeria\u0026rsquo;s context, where health insurance coverage is minimal and excludes advanced diagnostics and therapeutics, patients bear the full financial burden.\u003c/p\u003e \u003cp\u003eThe coping strategies employed by patients, including asset depletion, borrowing, and treatment abandonment, mirror patterns documented in other African contexts [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. These strategies, while enabling short-term access, have long-term consequences, including household impoverishment, indebtedness, and compromised health outcomes when treatment is delayed or abandoned. The absence of insurance coverage for nuclear medicine services represents a critical policy failure. International evidence demonstrates that expanding insurance coverage for cancer care improves access, reduces financial toxicity, and enhances health outcomes [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Nigeria\u0026rsquo;s recent efforts to achieve universal health coverage must prioritize inclusion of advanced diagnostics and therapeutics in benefit packages.\u003c/p\u003e \u003cp\u003eGeographic barriers in this study reflect the skewed distribution of specialised healthcare services in Nigeria. Patients travelling over 1,000 kilometres for treatment face not only financial costs but also physical discomfort, time away from family and livelihoods, and safety risks. This finding aligns with Otu\u0026rsquo;s documentation of geographic inequities in Nigerian healthcare and broader literature on distance as a barrier to healthcare access in Africa [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The concept of effective access, defined as the ability to reach services within an acceptable timeframe and at a reasonable cost, is clearly violated for most nuclear medicine patients in Nigeria [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. While UCH, Ibadan, provides high-quality services, the concentration of services in one or two centres nationally creates insurmountable barriers for geographically distant populations.\u003c/p\u003e \u003cp\u003eInternational evidence supports decentralisation of specialised services to improve equity [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. However, nuclear medicine presents unique challenges due to the capital intensity of equipment, workforce requirements, and radiopharmaceutical supply chains. Taiwo and Orunmuyi\u0026rsquo;s geospatial analysis proposed optimal locations for nuclear medicine clinics in Nigeria to maximise population coverage while maintaining service viability [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Implementing evidence-based geographic planning, coupled with investments in infrastructure and the workforce, could significantly improve accessibility. Telemedicine and tele-reporting models, successfully implemented in other resource-limited settings [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], offer potential solutions for extending nuclear medicine expertise to peripheral centres. Remote consultation, image interpretation, and patient education could reduce the need for long-distance travel while maintaining the quality of care.\u003c/p\u003e \u003cp\u003eThe critical role of social support networks in facilitating healthcare access is well-documented in African contexts [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. This study\u0026rsquo;s findings demonstrate that extended family systems, religious organisations, and community associations function as informal safety nets, mobilising financial, emotional, and practical support for patients. From a Weberian perspective, the mobilisation of social support represents value-rational and affectual social action, motivated by familial obligations, religious values, and emotional bonds rather than purely instrumental calculations. These social solidarity mechanisms reflect deep-rooted cultural values and have historically served as coping mechanisms in contexts of limited state welfare provision [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, this study also highlights the limitations and inequities associated with relying on informal support. Patients with weak social networks face significant disadvantages, resulting in a form of social capital inequality in healthcare access [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Moreover, the exhaustion of social support networks through repeated health crises and the spreading of financial burden across economically vulnerable families perpetuate cycles of poverty. The dual nature of social support, as both a facilitator and an indicator of system failure, has significant policy implications. While community-based health financing schemes and social health insurance can build on existing solidarity mechanisms [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], they must be formalised, universal, and adequately funded to provide sustainable and equitable protection. International evidence demonstrates that countries transitioning from informal to formal health financing systems can improve equity and financial protection [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe systemic barriers identified, including radiopharmaceutical supply disruptions, equipment downtime, and information gaps, reflect broader challenges in Nigeria\u0026rsquo;s health system, including inadequate funding, supply chain vulnerabilities, and weak health information systems [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. These findings align with international literature on nuclear medicine in low- and middle-income countries, which identifies infrastructure, workforce, regulatory, and supply chain challenges as significant constraints [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Addressing these systemic challenges requires multi-level interventions including infrastructure investment through upgrading and expanding nuclear medicine facilities with strategic geographic distribution, workforce development through training nuclear medicine physicians, medical physicists, radiopharmacists, and technicians, supply chain strengthening through local radiopharmaceutical production, diversification of suppliers, and regional collaboration, regulatory harmonization through streamlining regulatory frameworks to reduce operational costs while maintaining safety standards, and health information systems improvement through better patient education, referral systems, and communication.\u003c/p\u003e \u003cp\u003eThe barriers documented in this study have profound implications for health equity. Nuclear medicine services, essential for diagnosing and treating cancer and other non-communicable diseases, are effectively inaccessible to most Nigerians due to financial and geographic constraints. This creates a two-tiered system where wealthier urban populations can access advanced care while poorer and rural populations are excluded, perpetuating health inequities. The social determinants of health framework emphasizes that health inequities arise from unequal distribution of resources, power, and opportunities [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. In Nigeria\u0026rsquo;s context, inequitable access to nuclear medicine reflects broader structural inequalities, including poverty, geographic marginalisation, and inadequate public health financing. Addressing these inequities requires not only health sector interventions but also wider social and economic policies aimed at reducing poverty and regional disparities.\u003c/p\u003e \u003cp\u003eThis study has several strengths, including its patient-centred approach that prioritises patient voices and experiences, addressing a gap in predominantly biomedical nuclear medicine literature. The use of Weber\u0026rsquo;s Social Action Theory provides analytical depth and connects individual experiences to broader social structures. Multiple data sources, including patient, provider, and administrative data, along with systematic qualitative analysis, enhance credibility. The findings directly inform actionable policy recommendations. However, the study also has limitations. As a single-site study conducted at a single facility, the findings may not fully represent the experiences of other nuclear medicine centres in Nigeria. A cross-sectional design captures experiences at a single point in time, whereas longitudinal research can reveal how barriers evolve over the course of treatment trajectories. Selection bias exists as participants were patients who successfully accessed services, while those unable to access services are not represented. The findings are specific to Nigeria\u0026rsquo;s context, and transferability to other countries requires careful consideration of contextual differences.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reveals that financial barriers, geographic distance, and systemic healthcare challenges significantly restrict patient access to nuclear medicine services in Nigeria. While social support networks serve as critical facilitators, they are insufficient and inequitable, reflecting the absence of adequate formal health financing mechanisms. The findings underscore the urgent need for comprehensive policy interventions to improve equitable access to essential healthcare services. From a social science perspective, this research illustrates how structural inequalities, whether economic, geographic, or institutional shape individual health outcomes. Addressing these inequalities requires transformative changes in healthcare financing, service organisation, and health system governance.\u003c/p\u003e \u003cp\u003eBased on the study findings, we propose several evidence-based policy recommendations. First, expanding health insurance coverage is essential. Nuclear medicine services must be included in the National Health Insurance Scheme benefit package, covering both diagnostic and therapeutic procedures. Implementing risk-pooling mechanisms would make advanced cancer care affordable, while providing subsidies for low-income patients would ensure equity. Developing partnerships between the government, the private sector, and development partners could finance expanded coverage.\u003c/p\u003e \u003cp\u003eSecond, expanding access to nuclear medicine services would significantly improve access. Establishing regional nuclear medicine centres in Nigeria\u0026rsquo;s six geopolitical zones would reduce travel distances. Using geospatial planning tools to optimise facility locations for maximum population coverage, investing in infrastructure and equipment at strategically located tertiary hospitals, and implementing telemedicine and tele-reporting to extend specialist expertise to peripheral centres would all contribute to improved geographic accessibility.\u003c/p\u003e \u003cp\u003eThird, strengthening healthcare financing requires increasing public health expenditure to meet the Abuja Declaration target of 15% of government budgets. Establishing a dedicated cancer care fund to support infrastructure, workforce, and patient subsidies, and exploring innovative financing mechanisms, including sin taxes, donor funding, and public-private partnerships, would provide sustainable funding.\u003c/p\u003e \u003cp\u003eFourth, addressing supply chain challenges by supporting local radiopharmaceutical production would reduce dependence on imports and associated costs. Diversifying suppliers would minimise supply disruptions, while strengthening regional collaboration through the International Atomic Energy Agency and African regional bodies would facilitate technology transfer and supply chain coordination.\u003c/p\u003e \u003cp\u003eFifth, investing in workforce development through expanding training programs for nuclear medicine specialists, medical physicists, and radiopharmacists is crucial. Providing scholarships and incentives to attract and retain skilled professionals, and implementing task-shifting strategies where appropriate, would optimise workforce utilisation.\u003c/p\u003e \u003cp\u003eSixth, improving patient information and support through developing patient education materials about nuclear medicine services, referral processes, and what to expect would reduce anxiety and improve treatment adherence. Establishing patient navigation programs to guide patients through the healthcare system and creating support groups to provide peer support and information sharing would enhance patient experiences.\u003c/p\u003e \u003cp\u003eFinally, conducting implementation research to pilot-test interventions in different contexts before scale-up, evaluating the effectiveness and cost-effectiveness of various service delivery models, and engaging communities in designing and implementing interventions would ensure cultural appropriateness and sustainability.\u003c/p\u003e \u003cp\u003eThis study opens several avenues for future research, including comparative studies across multiple nuclear medicine centers in Nigeria and other African countries, longitudinal research tracking patient experiences and outcomes over time, economic evaluations of different financing and service delivery models, implementation research testing interventions to improve accessibility, and studies of patients unable to access services to understand the full extent of unmet need.\u003c/p\u003e \u003cp\u003eAchieving equitable access to nuclear medicine services in Nigeria is both a moral imperative and a public health necessity. As the burden of cancer and non-communicable diseases continues to rise, ensuring that all Nigerians can access essential diagnostic and therapeutic services is critical for improving health outcomes and achieving universal health coverage. This requires political will, sustained investment, and multi-sectoral collaboration. The voices of patients documented in this study underscore the human cost of healthcare inequities and the urgency of action.\u003c/p\u003e"},{"header":"List of Abbreviations","content":"\u003cp\u003eUCH University College Hospital\u003c/p\u003e\u003cp\u003ePET-CT Positron Emission Tomography- Computed Tomography\u003c/p\u003e\u003cp\u003ePET Positron Emission Tomography\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e Ethics approval for this research was obtained from the University of Ibadan/University College Hospital Institutional Review Board. Administrative from the Department of Nuclear Medicine, University College Hospital Ibadan. In addition, informed consent was obtained from all the participants, and they gave verbal consent to participate in the research before interviews were conducted. The researcher adhered to all the ethical principles as stipulated by the National Health Research Ethics Code (NHREC).\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eNot applicable\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eAuthors declare no conflict of interest.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study declare that no funding was received from any organization or individual\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAOA: Conceptualization, methodology, data collection, data analysis, writing—original draft. AO: Conceptualization, supervision, writing—review and editing. ASJ: Conceptualization, supervision, writing—review and editing.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors thank all patients, healthcare providers, and administrators who participated in this study. We acknowledge the support of the University College Hospital, Ibadan, and the Department of Sociology, University of Ibadan.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe qualitative data supporting this study’s findings are available from the corresponding author upon reasonable request, subject to ethical approval and participant consent provisions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Noncommunicable Diseases Country Profiles 2018: Nigeria. Geneva: WHO; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyandipo OO, Orunmuyi AT, Akande TO, Ogun OA. 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Lancet. 2008;372(9650):1661\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(08)61690-6\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(08)61690-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Patient accessibility, nuclear medicine, healthcare barriers, social support networks, Nigeria, health equity","lastPublishedDoi":"10.21203/rs.3.rs-8986443/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8986443/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eAccess to nuclear medicine services remains a critical challenge in sub-Saharan Africa, particularly in Nigeria, where advanced diagnostic and therapeutic technologies are concentrated in a few urban centres. Despite the clinical importance of nuclear medicine in managing cancer and non-communicable diseases, patient-centred research exploring the social dimensions of accessibility is limited. This study examined the barriers and facilitators influencing patient accessibility to nuclear medicine services at University College Hospital (UCH), Ibadan, Nigeria, from a social science perspective.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative, descriptive, cross-sectional study was conducted, using Max Weber\u0026rsquo;s Social Action Theory as the theoretical framework. Data was collected through 36 in-depth interviews with patients, 16 case studies, and 11 key informant interviews with healthcare providers and administrators. The data were analysed thematically using MaxQDA software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThree significant barriers emerged. First, financial constraints proved overwhelming, with patients paying between ₦80,000 and ₦750,000 for radioiodine therapy alone, excluding costs for accommodation, transportation, and subsistence. Second, geographic accessibility posed significant challenges, as patients had to travel long distances from across Nigeria due to the concentration of services in Ibadan. Thirdly, limited-service availability, including shortages of radiopharmaceuticals and equipment, further constrained access. Social support networks, particularly family and community contributions, emerged as the primary facilitator, enabling patients to overcome financial barriers through collective resource mobilisation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePatient accessibility to nuclear medicine services in Nigeria is severely constrained by financial, geographic, and systemic barriers. The heavy reliance on informal social support networks highlights the absence of adequate health financing mechanisms. Policy interventions should prioritise expanding health insurance coverage for cancer care, expanding nuclear medicine services, and strengthening healthcare financing systems.\u003c/p\u003e","manuscriptTitle":"Barriers and Facilitators to Patient Accessibility of Nuclear Medicine Services in Nigeria: A Social Science Perspective","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-02 15:55:07","doi":"10.21203/rs.3.rs-8986443/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-29T07:46:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-25T13:18:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-23T11:02:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-21T19:07:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-03-21T19:02:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0b5a1e7b-702a-4a08-b4cc-58a30ecb1d21","owner":[],"postedDate":"April 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-02T15:55:07+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-02 15:55:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8986443","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8986443","identity":"rs-8986443","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}