Beyond Access: Behavior Change and Gendered Realities in the Adoption of Digital Health Tools for Maternal, Newborn, and Child Health in Nigeria.

Abstract

Background and objective: Digital health innovations are increasingly being deployed to improve maternal, newborn, and child health (MNCH) outcomes in Nigeria. However, their adoption and effectiveness are influenced not only by technological access and infrastructure but also by behavioral factors, gender norms, and cultural contexts that shape user engagement and health-seeking behaviors.

Methods: A narrative review was conducted using PubMed, Web of Science, Scopus, and African Journals Online, covering studies published between 2015 and 2025. From an initial pool of records, 46 studies met the inclusion criteria following screening. This review synthesized empirical studies, program evaluations, and behavioral frameworks, such as the Fogg Behavior Model and Health Belief Model, to examine how gender dynamics, social hierarchies, and behavioral readiness shape digital MNCH adoption.

Results: The findings reveal that digital literacy gaps, gendered power relations, sociocultural beliefs, and intra-household decision-making processes significantly affect technology uptake. Interventions that incorporated voice-based content, local languages, and male-inclusive engagement strategies demonstrated higher levels of acceptance and retention in the target population. Behaviorally informed designs, culturally tailored messaging, and the involvement of trusted intermediaries, such as community health workers, were critical success factors.

Conclusion and global health implications: Effective digital health interventions must move beyond mere technical provision to integrate behavioral science and gender responsiveness into their design and delivery. Approaches that prioritize the lived realities of users, particularly women's agency within household decision-making, are more likely to achieve equitable and sustainable MNCH outcomes. Policy and program developers should prioritize human-centered, behaviorally intelligent, and gender-transformative digital health models, while future interventions must integrate cultural adaptability, motivational triggers, and inclusive engagement strategies to enhance digital MNCH impact.