Sociolinguistic Study of Gender and Health Literacy in Doctor–Patient Communication in Ilorin Hospitals

Cite this article as: Umar, M. A., & Yusuf, B. I. (2026). Sociolinguistic study of gender and health literacy in doctor-patient communication in Ilorin hospitals. Sokoto Journal of Linguistics and Communication Studies (SOJOLICS), 2(1), 549-559. https://doi.org/10.36349/sojolics.2026.v02i01.045

By

UMAR, Mudashir Ayinla

Department of English, School of Languages, Federal College of Education, Iwo

umarma@fceiwo.edu.ng

+2348064042578

&

YUSUF, Bolakale Ismail

Department of Languages (English Unit), Al-Hikmah University, Ilorin

abubakrismail16@gmail.com

+2347031532299

Abstract

Doctor–patient communication is widely recognised as a fundamental component of effective healthcare delivery. However, in multicultural societies such as Nigeria, communication between healthcare professionals and patients is often shaped by sociocultural factors including gender norms, educational background, and health literacy. This study investigates how gender differences and patients’ educational levels influence doctor–patient interaction in Ilorin, North-Central Nigeria. Drawing on qualitative data from semi-structured interviews and video-recorded consultations involving ten (10) doctors and eighteen (18) patients in a public hospital, the research adopts Communication Accommodation Theory and Interactional Sociolinguistics as analytical frameworks. The findings reveal that gender concordance significantly affects patient disclosure of sensitive health issues, particularly among female patients who prefer consultations with female doctors due to religious and cultural expectations of modesty. Educational disparities also influence patient participation and comprehension of medical instructions, although doctors frequently employ communicative accommodation strategies such as code-switching, simplified language, and repetition to mitigate these barriers. Despite these strategies, power asymmetries and health literacy gaps remain significant obstacles to patient-centred communication. In conclusion, the study highlights the importance of culturally responsive communication training in Nigerian medical education and recommends policy interventions aimed at improving health literacy and gender-sensitive healthcare delivery.

Keywords: doctor–patient communication, gender dynamics, health literacy, sociolinguistics, North-Central Nigeria, Communication Accommodation Theory

1.         Introduction

Language use and its understanding play an unavoidable role in human daily routine. In connection to this, effective communication between healthcare providers and patients is widely recognised as a cornerstone of quality medical care (Kee et al., 2018). Successful clinical outcomes depend not only on biomedical expertise but also on the ability of doctors to communicate clearly, empathetically, and effectively with patients (Ranjan, Kumari&Chakrawarty, 2015). Research consistently demonstrates that effective doctor–patient communication improves diagnostic accuracy, treatment adherence, patient satisfaction, and overall health outcomes (Street et al., 2022).

In developing countries, communication barriers in healthcare settings are often intensified by linguistic diversity, cultural norms, and socio-economic inequalities. Nigeria provides a particularly complex context for examining these challenges (Medubi&Gambari-Olufadi, 2025). The country has more than 500 indigenous languages and multiple cultural traditions, making communication in healthcare settings highly diverse and often unpredictable. While English serves as the official language and the primary language of medical training, many patients possess limited proficiency in English and varying levels of health literacy (Odebunmi, 2022).

Health literacy refers to the ability of individuals to obtain, process, and understand basic health information necessary for making informed decisions about their healthcare (Mustajoki, 2015).  Limited health literacy is associated with poorer health outcomes, misunderstanding of treatment instructions, and reduced participation in clinical decision-making (World Health Organization, 2022).

In addition to literacy challenges, sociocultural factors such as gender norms influence communication in medical encounters. Gender expectations can affect how patients describe symptoms, how doctors interpret patient complaints, and how comfortable patients feel discussing sensitive health issues. Studies across different countries indicate that patients often prefer physicians of the same gender when discussing reproductive or sexual health issues (Shen et al., 2023).

In Nigeria, gender dynamics in healthcare are strongly influenced by religious beliefs and cultural expectations regarding modesty and privacy. Female patients may feel uncomfortable discussing reproductive health issues with male physicians, while male patients may hesitate to discuss emotional or psychological problems with female doctors (Pagano, 2018).

This study therefore explores the intersection of gender and education in shaping doctor–patient communication in Ilorin, a culturally diverse city in North-Central Nigeria. By examining real clinical interactions and participant experiences, the research aims to contribute to a deeper understanding of sociolinguistic barriers in Nigerian healthcare communication (Sheeranetc al., 2023).

Background of Healthcare Communication in Nigeria

Healthcare communication in Nigeria operates within a complex social and institutional environment characterised by limited resources, high patient-to-doctor ratios, and significant linguistic diversity (Raddawi, 2015). Public hospitals frequently experience overcrowding and heavy workloads, which can reduce consultation time and hinder effective interaction between doctors and patients.

Research conducted in Nigerian hospitals shows that effective communication plays a crucial role in improving healthcare delivery, facilitating accurate diagnosis, and increasing patient satisfaction. However, systemic challenges such as heavy patient loads, administrative inefficiencies, and cultural misunderstandings often impede communication between healthcare providers and patients (Coran, Koropeckyj-Cox & Arnold, 2013).

In addition to institutional constraints, communication barriers arise from differences in educational attainment and language proficiency. Many patients rely on local languages or Nigerian Pidgin during consultations, while medical professionals are trained primarily in English and often use specialised medical terminology that patients may not fully understand (Hayes et al., 2017).

Studies in Nigerian hospitals also highlight the importance of communication skills among healthcare providers. Doctors who engage in active listening, empathy, and collaborative decision-making tend to foster stronger relationships with patients and achieve better treatment outcomes (Rocque&Leanza, 2015).

However, despite the recognised importance of communication, many Nigerian healthcare systems lack structured training in doctor–patient interaction, leaving physicians to develop communication strategies informally during clinical practice. This is the core target of this study and the impending literature gap to fill. 

1. 1      Statement of the Problem

Effective doctor-patient communication is a significant challenge in Nigerian healthcare settings, particularly in culturally diverse cities like Ilorin. Despite its importance in achieving quality medical care, communication barriers persist due to linguistic diversity, cultural norms, and socio-economic inequalities. Patients limited English proficiency, varying health literacy levels, and gender-related modesty concerns hinder effective interaction, compromising diagnostic accuracy, treatment adherence, and patient satisfaction.

With regard to the above stated, this study addresses a pressing need to understand the sociolinguistic barriers in Nigerian healthcare communication, specifically exploring how gender and education intersect to shape doctor-patient interaction. By examining real clinical interactions and participant experiences, this research aims to inform strategies for improving communication, health literacy, and patient outcomes in resource-constrained settings. The findings will contribute to developing context-specific interventions, enhancing healthcare providers' communication skills, and ultimately, promoting more equitable and effective healthcare delivery in Nigeria.

1. 2      Research Objectives

This paper addresses two key objectives:

i. To examine the impact of gender differences on doctor–patient interaction.

ii. To investigate how patients’ educational levels influence comprehension and communication during clinical consultations.

2.         Literature Review

Gender Dynamics in Healthcare Communication

Gender is an important sociological factor influencing communication styles, interpersonal relationships, and healthcare interactions. Research suggests that male and female physicians often exhibit different communication styles during clinical encounters (Schmid Mast et al., 2022).

Female physicians tend to adopt more patient-centred communication approaches characterised by empathy, emotional engagement, and longer consultation times. These communication patterns often lead to higher patient satisfaction and improved therapeutic relationships (Schmid Mast et al., 2022).

Gender concordance between doctor and patient has also been shown to influence patient disclosure. Patients frequently report greater comfort discussing sensitive issues such as sexual health, reproductive health, and psychological distress with physicians of the same gender. A systematic review by Shen et al. (2023) found that gender concordance improves patient trust and increases the likelihood of full disclosure of symptoms.

In societies where cultural norms emphasise modesty and privacy, gender concordance becomes even more significant. Research on maternal healthcare in Northern Nigeria demonstrates that some women delay or avoid medical consultation due to discomfort with male healthcare providers (Medubi&Gambari-Olufadi, 2025). These findings suggest that gender dynamics are not merely interpersonal preferences but are embedded in broader sociocultural systems that shape healthcare experiences.

2. 1      Educational Level and Health Literacy

Educational attainment significantly influences patients’ ability to understand medical information (Trueheart, 2018).  Individuals with higher levels of education are generally more likely to understand medical terminology, ask questions during consultations, and participate in shared decision-making (Sentell et al., 2023).

Conversely, patients with limited education may struggle to understand complex medical explanations, leading to misunderstandings regarding diagnoses or medication instructions (Pagano, 2018). Health literacy therefore plays a crucial role in determining the effectiveness of doctor–patient communication.

Globally, limited health literacy has been linked to poorer health outcomes, higher hospitalisation rates, and increased healthcare costs (Sentell et al., 2023). In Nigeria, these challenges are compounded by linguistic diversity and unequal access to educational resources.

A survey of patient perceptions in Nigerian hospitals found that communication clarity, respect, and information adequacy significantly influence patient satisfaction with healthcare providers (Odebunmi, 2021).

Doctors often attempt to overcome literacy barriers by simplifying language, using metaphors, or switching to local languages during consultations. These strategies align with theories of communication accommodation, which emphasise adaptation to the linguistic needs of interlocutors (Pagano, 2018).

2.2       Communication Barriers in Nigerian Healthcare

Several factors contribute to communication difficulties in Nigerian healthcare settings. First, language differences often complicate clinical interactions. Many patients prefer to communicate in indigenous languages or Nigerian Pidgin, while doctors primarily use English. Second, cultural beliefs about illness and healing may conflict with biomedical explanations. Some patients rely on traditional medicine or spiritual healing practices alongside hospital treatment. Third, systemic constraints such as limited consultation time and high patient volumes reduce opportunities for detailed communication (Brown, 2016).

Research evaluating physician–patient communication in healthcare delivery found that factors such as physician communication skills, patient health literacy, and working conditions significantly influence communication outcomes (Odebunmi, 2022). These findings underscore the importance of examining communication barriers within broader social and institutional contexts.

3.         Theoretical Framework

This study is guided by two complementary theoretical frameworks: Giles (1975, 1979, 1980, 2007) Communication Accommodation Theory (CAT), and Gumperz and Cook-Gumperz (2012) Interactional Sociolinguistics.

Communication Accommodation Theory explains how speakers adjust their communication styles in response to their interlocutors. Individuals may converge by adopting similar speech patterns or diverge by emphasising linguistic differences to signal social distance.

Interactional Sociolinguistics focuses on how meaning is constructed in conversation through contextual cues and cultural knowledge. It emphasises that communication is shaped by social relationships, cultural expectations, and power dynamics.

In healthcare settings, doctors frequently accommodate patients by simplifying language, slowing speech, or switching to local languages to facilitate understanding. Together, these frameworks provide a comprehensive lens for analysing doctor–patient communication in multicultural healthcare settings.

4.         Data and Methodology

4. 1      Research Design

The study adopted a qualitative research design to explore communication dynamics in natural clinical settings.

4. 2      Participants

Participants included ten (10) general practitioners and eighteen (18) patients. They were selected through purposive sampling to ensure diversity in gender, educational background, and linguistic experience, and doctors’ work experience. These three factors are captured in each of the demographic tables for patients and doctors below:

Table 1: Basic Demographics and Characteristics of Patients

S/N	Pseudonyms	Gender	Education	Language spoken
1	Participant 1	Male	Primary education	Yoruba
2	Participant 2	Female	Primary education	Igbo
3	Participant 3	Female	Tertiary education	Yoruba
4	Participant 4	Male	Secondary	Yoruba
5	Participant 5	Male	Secondary	Yoruba
6	Participant 6	Female	Secondary	Hausa
7	Participant 7	Female	Primary	Igbo
8	Participant 8	Male	Primary	Hausa
9	Participant 9	Female	Secondary	Igbo
10	Participant 10	Male	Primary	Yoruba
11	Participant 11	Male	Primary	Yoruba
12	Participant 12	Female	Secondary	Yoruba
13	Participant 13	Female	Primary	Yoruba
14	Participant 14	Male	Primary	Igbo
15	Participant 15	Female	Primary	Yoruba
16	Participant 16	Male	Primary	Yoruba
17	Participant 17	Male	Primary	Yoruba
18	Participant 18	Female	Secondary	Yoruba

 

Table 2:  Basic Demographics of the Doctors

S/N	Pseudonym	Gender	Language Spoken	Work experience
1	Dr. A	Male	Yoruba	More than 10 years
2	Dr. B	Male	Yoruba	More than 10 years
3	Dr. C	Male	Yoruba	Between 5 and 10 years
4	Dr. D	Male	Yoruba	Less than 5 years
5	Dr. E	Male	Yoruba	Between 5 and 10 years
6	Dr. F	Female	Igbo	More than 10 years
7	Dr. G	Female	Igbo	Between 5 and 10 years
8	Dr. H	Female	Igbo	More than 10 years
9	Dr. I	Female	Hausa	Between 5 and 10 years
10	Dr. J	Female	Yoruba	More than 10 years

 

4. 3      Data Collection

The two primary methods used for this investigation are:

- Semi-structured interviews with doctors and patients.

- Video recordings of 18 doctor–patient consultations.

4. 4      Ethical Considerations

Informed consent was obtained from all participants before data collection. Participants were informed of their right to withdraw at any time without negative consequences. Confidentiality and anonymity were maintained through use of pseudonyms and modification of identifiable details. All audio and video recordings were securely stored to protect participant privacy. The study also received ethical approval from relevant institutional review boards before being undertaken.

5.         Analysis and Discussion

5. 1      Data Analysis

Data were transcribed and analysed using thematic analysis following Braun and Clarke’s framework based on the two research objectives thus:

5. 1. 1 Impact of Gender on Doctor-Patient Interaction

The interplay between gender and doctor-patient interaction in Nigerian healthcare settings reveals complex dynamics influenced by cultural, religious, and societal factors. Patient interviews demonstrate nuanced gender preferences, with many initially denying preferences but later acknowledging same-gender inclinations, particularly for sensitive health issues. Female patients exhibit stronger preferences, driven by shyness and modesty concerns, especially regarding reproductive health.

A hierarchical preference pattern emerges, especially among Muslim patients, ranking Muslim female doctors highest and non-Muslim male doctors lowest, reflecting intersections of religion and modesty norms. Doctors acknowledge gender's impact on interactions, noting female patients' verbosity and shyness, and male patients' discomfort with opposite-sex discussions. However, perspectives vary, with some doctors seeing gender as a barrier and others downplaying its significance.

These findings align with recent Nigerian healthcare discourse, highlighting women's preferences for female providers due to cultural and religious reasons, and broader patriarchal norms around modesty. The study underscores gender's profound influence on healthcare interactions, disclosure, and satisfaction, suggesting tailored approaches may improve patient outcomes.

5. 1. 2  Impact of Patients' Level of Education on Doctor-Patient Interaction

The interplay between patients' educational level and doctor-patient interaction in Nigerian healthcare settings reveals complex dynamics. Doctors identify education as a significant factor affecting communication, attributing approximately 60% of difficulties to patients' education levels. However, education alone doesn't determine success; patient cooperation, personality, and health literacy also play crucial roles. While educated patients may facilitate communication, highly educated ones can pose challenges due to perceived medical authority.

Doctors employ code-switching between English and local languages to accommodate patients' literacy levels, enhancing understanding and building rapport. This aligns with Communication Accommodation Theory and bridges health literacy gaps, allowing patients to convey urgency or distress authentically. Patients with limited formal education report understanding instructions, but observations reveal instances where medical terminology is used without clarification, highlighting doctors' responsibility to ensure comprehension.

The findings underscore the need for tailored communication strategies, empowering patients to ask questions, and leveraging the broader healthcare team to compensate for gaps. Education's impact on doctor-patient interaction is nuanced, interacting with patient cooperation, personality, and cultural context. Effective communication requires adaptability, cultural sensitivity, and awareness of patients' needs, regardless of education level.

5. 2      Discussion of Findings

The findings demonstrate that:

- gender norms and educational disparities significantly shape doctor–patient communication in Nigerian healthcare settings,

- gender concordance enhances patient comfort and encourages disclosure of sensitive health issues,

- educational disparities create challenges for comprehension, highlighting the importance of health literacy initiatives.

To be clearer, this study has so far shown that gender emerged as a major factor influencing patient comfort during consultations. On the first hand, It was seen that female patients frequently expressed a preference for female doctors when discussing reproductive or intimate health issues. This preference was strongly linked to cultural and religious expectations of modesty. On the other hand, male patients also reported discomfort discussing certain health conditions with female doctors. Based on this, it was noted that doctors demonstrate an understanding of cultural and religious diversity and show respect for patients’ faith, beliefs, and values to avoid misinterpretation of clinical touch.

Also, it was revealed that educational disparities influenced patient comprehension of medical explanations. Patients with higher education levels tended to ask more questions and engage more actively in consultations. However, patients with limited education often relied on pharmacists or family members to interpret doctors’ prescriptions. For instance, doctors argued that the lack of patients’ medical knowledge when explaining their illnesses was associated with low health literacy. As a result, patients may be at high risk of medication mix-ups and dosage errors. This finding calls for policymakers and governments to enhance patients’ health education, enabling them to communicate more effectively with doctors and avoid adverse health outcomes.

Nevertheless, it was observed that doctors frequently used several strategies to facilitate understanding. This includes code-switching into local languages, repetition of key information, and simplified explanations. These strategies improved communication but did not fully eliminate power asymmetries. This behaviour from doctors to their patients showed that training on appropriate non-verbal behaviors in clinical consultations go a long way to improve patient outcomes and satisfaction.

6.         Conclusion

Doctor–patient communication in Nigeria is influenced by complex sociocultural and educational factors. Therefore, this study underscores the importance of symmetry understanding between the two parties concerned (patient and doctor) if any positive healthcare achievements are to be made. Based on the findings of this paper, improving communication in health sector, particularly between doctor and patient requires the following: intensive communication training in medical education, gender-sensitive healthcare policies and improved patient health literacy programmes. These interventions can strengthen therapeutic relationships and improve healthcare outcomes in the sense that the patient sees the doctor, however the diversity of their language and ethnicity, as a confidant and experienced medical expert that can guarantee their sound and positive health status.

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