OPERATIONAL CHALLENGES AND SOCIO-CULTURAL INFLUENCES ON E-HEALTH ADOPTION FOR MATERNAL AND CHILD HEALTH IN RURAL NASARAWA STATE

Maternal and child mortality remain critically high in rural Nigeria, with Nasarawa State recording maternal mortality ratios between 814 and 1,047 per 100,000 live births. Digital health (eHealth) technologies, particularly mobile health (mHealth) interventions, have been promoted to bridge access gaps. However, their success depends on addressing operational and socio-cultural barriers. This study examined the challenges faced by healthcare providers and mothers, and the influence of socio-cultural factors on eHealth adoption for maternal and child health in rural Nasarawa State. A descriptive cross-sectional mixed-methods design was conducted in four rural Local Government Areas (Awe, Nasarawa Eggon, Kokona, Doma). Using multistage sampling, 394 women of reproductive age (15–49 years) completed a structured questionnaire (response rate 95%). Twenty‑five key informant interviews were conducted with health workers and community leaders. Quantitative data were analysed using descriptive statistics and one‑sample t‑tests (p<0.05); qualitative data underwent thematic analysis. Respondents strongly agreed with all challenge items (grand mean=3.21±1.21). The most prominent challenges were poor electricity supply (mean=3.51), lack of training/support (mean=3.48), fear of misinformation (mean=3.44), poor network connectivity (mean=3.42), and inability to afford smartphones (mean=3.21). One‑sample t‑test confirmed significant challenges (M=20.98, SD=4.11; t=14.35, p<0.001). Socio‑cultural factors significantly influenced eHealth adoption (grand mean=3.29±1.17; t=19.71, p<0.001), including need for husband’s permission (mean=3.63), privacy concerns (mean=3.51), and cultural/religious beliefs discouraging women’s technology use (mean=3.18). Community meetings were rated as effective awareness channels (mean=3.75). Qualitative findings corroborated these barriers. Healthcare providers and mothers in rural Nasarawa State face significant multi‑dimensional operational challenges, and socio‑cultural factors profoundly influence eHealth adoption. Addressing these barriers requires targeted investments in rural digital infrastructure, literacy‑adapted voice‑based interventions, gender‑responsive policies, and community engagement. Without such measures, eHealth risks widening existing health inequities rather than reducing them.