Integrated Strategies Addressing Predisposing, Enabling, and Illness-Level Factors Influencing Healthcare-Seeking Behavior among Pregnant Women and Newborn Mothers: Insights from Sierra Leone

Abstract

Background Maternal and newborn health outcomes in Sierra Leone remain among the poorest globally, driven by a complex interplay of socio-demographic, systemic, and behavioral factors. Understanding how integrated strategies influence healthcare-seeking behavior is critical for tailoring interventions that reduce delays and improve maternal outcomes. This study aimed to identify high-impact strategies addressing predisposing, enabling, and illness-level factors that affect maternal and newborn healthcare-seeking behavior in Bo District, Sierra Leone. Methods A descriptive cross-sectional study was conducted at Bo Government Hospital (urban) and Tikonko Maternity Home (rural) between January – May 2024. Using simple random sampling, 500 participants (294 pregnant women and 206 mothers of children under five) were selected from facility attendance lists. Quantitative data was collected through structured interviews using a digital questionnaire administered via the ONA platform. Descriptive analysis was performed using SPSS version 26 to identify patterns in healthcare-seeking preferences and perceived effectiveness of integrated health strategies. Results The mean age of pregnant participants was 24.83 years (SD = 4.74), and the average household income showed substantial disparity (Mean = 335.03 NLE; SD = 668.49). Regarding predisposing factors, the preferred strategies included prenatal education (25.91%) and community outreach for early antenatal care (24.12%). Enabling factors were most influenced by transportation support (24.6%) and access to affordable care (24.21%). Illness-level strategies prioritized by participants included strengthening maternal health surveillance systems (27.55%) and prenatal screening services (23.08%). Education level, income, and parity were key determinants of healthcare-seeking behavior. Conclusion Integrated strategies that combine health education, community outreach, logistical and financial support, and health system strengthening are the most effective in influencing maternal and newborn healthcare-seeking behavior. Culturally tailored, equitable, and evidence-informed approaches help improve maternal health service utilization in low-resource settings like Sierra Leone.