Effectiveness of Patient-Centered Care Interventions on Provider Communication, Patient Engagement, and Retention in Nigeria’s National Health Insurance Scheme: A Randomized Controlled Trial with Embedded Qualitative Component

Background: Despite increasing global adoption of Patient-Centered Care (PCC), its integration into Nigeria’s National Health Insurance Scheme (NHIS) is hindered by structural inefficiencies, provider workload burdens, and patient engagement gaps. This study evaluates the impact of PCC interventions on provider-patient communication, decision-making involvement, and NHIS enrollee retention while identifying key systemic barriers to implementation. Methods: A Randomized Controlled Trial with Embedded Qualitative Component was employed, combining a randomized controlled trial of 376 NHIS enrollees with a qualitative inquiry involving 20 purposively selected participants. The intervention comprised a PCC training program for healthcare providers in the Surgical Outpatient (SOP) clinic, with PCC-exposed participants receiving care over a three-month period. Pre- and post-intervention outcomes—communication satisfaction, decision-making involvement, and NHIS retention—were measured using structured questionnaires. Quantitative analyses included t-tests, chi-square, regression modeling, and interaction effects, with effect sizes reported using Cohen’s d and eta squared (η²), and significance set at p < 0.05 (SPSS v26). Qualitative data were analyzed thematically and narratively using MAXQDA, with integration achieved through triangulation and joint displays . Results: PCC interventions significantly improved provider responsiveness (p = 0.0006), shared decision-making (p < 0.01), and NHIS retention (p = 0.0003). Enrollees in the PCC group reported greater satisfaction with communication (mean = 3.78 vs. 2.92) and decision-making support (mean = 3.22 vs. 2.51). Logistic regression showed PCC exposure was strongly associated with high retention (OR = 2.78, p < 0.001), alongside low income (OR = 1.62, p = 0.031). Subgroup analysis revealed greater effects among older, female, and less-educated participants. Qualitative findings confirmed these trends, highlighting trust, family involvement, and dissatisfaction with delays and medication stockouts. Findings are contextualized using Systems Theory, Expectation-Confirmation Theory and Self-Determination Theory. Conclusion : PCC interventions significantly enhances provider responsiveness, communication satisfaction, patient involvement in decision-making, and enrollee retention, particularly among older, female, and less-educated populations. However, persistent system-level barriers—such as provider workload, short consultation time, and administrative inefficiencies—limited the full realization of PCC benefits. These findings underscore the need to align PCC strategies with operational reforms to ensure equitable and sustainable patient-centered care within NHIS facilities. Trial Registration : This study was registered retrospectively with the Pan African Clinical Trials Registry (PACTR202105768231241) on 2 June 2025.