Layered expressions of agency in Nigerian women’s health and household decision-making during the COVID-19 pandemic

During the Coronavirus Disease 2019 (COVID-19) pandemic, women in low-resource settings faced significant disruptions to healthcare access and household stability. While existing research has documented service barriers and vulnerability, less attention has been given to how women interpret and navigate health-related decision-making under crisis conditions. This study aimed to examine how selected Nigerian women described and interpreted health-related and household decision-making during the COVID-19 pandemic, with particular attention to different forms of agency expressed within social and institutional constraints. A secondary qualitative analysis was conducted using semi-structured interview data collected between August and November 2022 as part of a larger study on women’s health-seeking behaviour in Nigeria. Interpretative Phenomenological Analysis (IPA) guided in-depth examination of narratives from 15 purposively selected participants whose interviews contained detailed reflections on decision-making processes. Analysis focused on experiential meaning, relational negotiation, moral reasoning, and faith-informed coping practices. Three interpretive layers of agency expression were developed inductively, drawing on Smith’s concept of “gems” in IPA: “shining” (public and relational decision-making), “suggestive” (negotiated and situational strategies), and “secret” (interior and faith-informed coping). Across these layers, women described exercising agency through coordination with family members, ethical management of limited resources, and culturally embedded meaning-making practices. Agency was often expressed in context-dependent and relational ways rather than through overt individual autonomy. The findings highlight the diverse ways agency may be enacted during crisis conditions and underscore the value of qualitative approaches for understanding health decision-making in constrained settings. Although not intended to be statistically generalizable, these insights may offer insight for more context-sensitive health communication strategies.