Framework inf luencing healthcare ser vices utilization: Impact on maternal health-seeking behaviour and key factors

Introduction: Maternal and neonatal mortality remain critical challenges in Sub-Saharan Africa, with  Sierra Leone among the worst-affected countries. Barriers such as socio-cultural norms, financial constraints, and limited infrastructure hinder healthcare-seeking behaviors among pregnant women and mothers in rural areas. This study examines the influence of protective, alleviating, and aggravating factors on healthcare-seeking behavior among pregnant women and newborn mothers in Bo District, Sierra Leone. Materials and Methods: A mixed-methods study was conducted among 500 participants, including 294 pregnant women and 206 newborn mothers, at Bo Government Hospital and Tikonko Village Health Center. Data were collected via structured questionnaires and analyzed using Chi-Square, logistic regression, and Structural Equation Modeling (SEM) to assess relationships among influencing factors. Results: Protective factors, including health education and preventive care awareness, significantly influenced healthcare-seeking behavior, reported by 97.2% of participants. Alleviating factors such as access to healthcare (20.29%) and financial support (15.1%) promoted high antenatal care utilization (100%) and facility-based delivery (99.03%). Aggravating factors like cultural barriers and perceived risks negatively impacted care-seeking, with SEM showing a significant indirect effect (β = -0.45, p < 0.001). Conclusion: Health education, accessibility, and financial support are critical for improving maternal and neonatal health outcomes. Addressing socio-cultural barriers and enhancing risk communication are essential for further progress. Policymakers should prioritize integrated strategies to reduce maternal and neonatal mortality in Sierra Leone.