When the Coronavirus Disease 2019 (COVID-19) became a pandemic in March 2020, the World Health Organization (WHO) worked with other global partners and country health systems to roll out the COVID-19 treatment guidelines, protocols, standard operating procedures (SOPs) and best practices [1]. The rollout was done at the national level, with each stratum of government mandated to ensure that they are adhered to within the country. The guidelines cover a spectrum of topics, including management of cases, testing procedures and sensitization. However, implementation of these guidelines at country level differs, and is affected by several factors that are related to care- seeking behaviour of citizens [2, 3].

In order to ensure the successful management of COVID-19, the compliance of individuals to stipulated guidelines for prevention and control is greatly determined by their knowledge, attitudes and practices [4]. Nigeria has increased its testing capacity to facilitate extensive testing, with an average testing rate of 6.4% as of 2nd February 2022 [5]. The effectiveness of mass and rapid testing depends not only on how the tests are conducted, but the willingness of citizens to be tested among other factors. Voluntary random testing is highly recommended and has been found to be effective in some countries [6]. This, however, has been mentioned to lead to systematic selection bias because individuals who prefer to learn about their health status are the most likely to seek voluntary testing [7]. Several factors could affect or influence this preference. Tijani et al. [8] reported in their study that distance to facility, preexisting health conditions, knowledge of COVID-19 symptoms, previous healthcare experience, type and frequency of communication influence healthcare seeking behavior of Nigerians, specifically during the COVID-19 pandemic. It should be noted, however, that factors that could influence testing behaviours are vast and could vary based on environment, knowledge of the people of concern as well as even cultural practices of certain areas [9].

In Nigeria, Lagos and Ondo represent two states with different archetypes. Both states have reported COVID-19 cases since the onset of the pandemic 98,693 cases in Lagos and 5,173 in Ondo state as of 16th February 2022 [5]. Despite the desire by the national and state governments to ensure a more equitable distribution of health resources, glaring disparities in healthcare delivery are still evident. This is anticipated to affect the proportion of people who tested for COVID-19. In order to ascertain the factors affecting testing behaviours in south western Nigeria, there is therefore a need to assess these factors amongst citizens of Ondo and Lagos States.

This study undertakes an in-depth look into the factors affecting individual testing for COVID-19, cutting across two states in south western Nigeria, Lagos state being the epicenter of the disease and Ondo state having relatively low prevalence. Results revealed that very few of the participants were willing to be tested for COVID-19 in both states. The small proportion of willingness exhibits great disparity with the results of Ukwenya [10] which revealed a great level of willingness to be tested among participants in Ondo state. The disparity between our findings and that of Ukwenya [10] could be as a result of a difference in study population. While our study population involved a mixture of urban, semi-urban and rural areas in both states, Ukwenya’s study population covered Akure, an urban area in Ondo state. Furthermore, our study was conducted at a period of reduced positive cases in Lagos and Ondo, when the wave of COVID-19 was flattening. Our results revealed the need to promote willingness for COVID-19 tests nationwide, excluding no one, as participants showed little concern in knowing their health status especially among rural dwellers. This is important as such knowledge will allow them to 1) rapidly eliminate uncertainty concerning their COVID-19-related health status; 2) enjoy healthcare benefits at an early stage if infected, thereby increasing the chances of a quick recovery; 3) actively prevent infecting others within their immediate environment, such as family and friends, as well as contacts in other relevant settings (work, school, church) and 4) obtain proof of no active infection, e.g., to avoid a quarantine when traveling internationally or having been in contact with an active infection case [11].

The age group 30–49 had the highest percentage of people who reported that they had tested and were also interested in testing for COVID-19 in Lagos and Ondo state. This interest in testing could be attributed to the mobile nature of people in this age bracket, coupled with compulsory testing imposed on members in this age group by reason of their places of work and businesses. People in this age bracket also constitute a higher percentage of the work force in Nigeria [12]. However, the group with the larger set of participants not willing to test were aged 29 and below, this could be because members of these age group have been reported to be less susceptible to coming down with severe COVID-19, with majority of the people of this age bracket showing mild symptoms or being asymptomatic [13]. This peculiarity, hampers their interest to test. Individuals from 60 years and above showed the least values for being tested or showing willingness to test. There was no significant association between Gender, marital status and COVID-19 testing behaviour. There was, however, a significant association between education levels and testing behaviour in Lagos, with the major percentage of those who reported to have tested being from tertiary institutions, furthermore, the same category had more people who were willing to test. Ondo state also showed similar pattern of association. This could be as a result of improved knowledge and better exposure, to information which could encourage good health seeking practices [8].

Our study showed that internet access as well as possession of a technological device, had a significant association with testing behaviour. Majority of the respondents reported having access to the internet at least once in a day and also possessing more than one device. More people who stated that they had done a COVID-19 test, also stated that they had access to the internet at least once in a day. The internet has become a major source of information hence, access to the internet can also be a factor for improving knowledge which could drive awareness and encourage testing [14]. However, there were still a lot of respondents who had access to the internet and yet were not interested in testing, which could also be as a result of the abundance of false news and wrong ideologies concerning the COVID-19 disease, that was being spread during the pandemic, with the internet used as a tool for such propagation [14].

With the advent of the COVID-19 infection, several underlying medical conditions were being discovered to be associated with COVID-19 leading to complications and resulting in mortality in most cases [15, 16]. This study revealed that a higher proportion of the population that tested in Lagos and in Ondo state were aware of the predisposing factors that increase the risk of contracting COVID-19, as well as the symptoms associated with COVID-19. Among those reporting not to have tested, the majority of them had no knowledge of COVID-19 predisposing factors as well as its symptoms. This shows that knowledge levels of a population about COVID-19 symptoms also affects the willingness to test in that population, these findings are similar to studies by Akwa and his colleagues [17, 18]. Akwa, in his study, reported that more than 80% of respondents had a good knowledge of the symptoms of COVID-19 which influenced their willingness to test. Hence, it can be inferred that knowledge about the symptoms and risk factors need to be encouraged to improve testing and curb the spread of COVID-19 disease.

Majority of Participants who reported that they had family members who tested positive for COVID-19, had also either tested or were willing to test. The result shows that having a relative or a close contact test positive for COVID-19 could encourage one to get tested. Another factor identified was awareness of testing centers, knowing where to get a COVID-19 test done also imparts testing behaviour. A large number of participants who had not tested for COVID-19 were also not aware of a testing center. The case was different for those who had tested or even those willing to test, as a good number of them were aware of a testing center. This finding was quite similar to a study carried out in Cameroon by Akomoneh [19] who reported that the majority of participants in his study either did not have testing sites or were not aware of a testing site. In major parts of Africa, especially Nigeria, where testing centers are not readily accessible in all areas, distance and time taken to reach a testing center can also pose a threat to an individual’s willingness to test. Our findings showed that a larger amount of people was situated within 5km-10km of the nearest testing center in Lagos and more than 10 km in Ondo state, however, majority of the participants who had tested or were willing to test for COVID-19 were situated less than 5km from a testing center in both states. The distance from the nearest testing center could be one of the reasons for low patronage in Lagos state and much more in Ondo. The low testing numbers can be attributed to the fact that there were not enough testing centers in the country, making access quite difficult for a larger percentage of people, especially those living in rural areas [20, 21]. Few respondents from Lagos State also reported that they have been turned away from a testing center citing reasons which includes; being asymptomatic, crowded centers and insufficient funds to transport themselves to the testing centers. On the contrary, this was not evident among participants in Ondo state with no case of reporting being turned away from any testing center.

Overall, the study highlighted, Education levels, family members who tested positive, awareness of testing centers, computer and internet access, as well as knowledge of pre-existing conditions and symptoms associated with COVID-19 as factors that could affect COVID-19 testing behaviour.