Purpose This study explored the health beliefs, experiences and self-management practices of adults living with non-specific chronic low back pain (CLBP) in a rural community in South-Eastern Nigeria. This was in order to identify potential biopsychosocial factors associated with CLBP to inform the development of a self-management programme for CLBP in rural Nigeria.

Relevance CLBP has a high prevalence of around 70% among rural Nigerian adults, with an associated vicious cyclical tendency of increasing disability, deepening poverty, reducing quality of life and reinforcing inequality in Nigeria. In addition, Nigerian rural dwellers have very limited access to Physiotherapy due to poor availability and unaffordable cost. Therefore, a physiotherapist-led self-management approach may be appropriate in this setting. In order to apply this to a rural African context, a pre-requisite is an in-depth understanding of the biopsychosocial factors associated with CLBP.

Participants A total of 30 participants with CLBP took part in this study. They were selected by purposive sampling using socio-demographic factors such as age, sex and occupation to reflect a diversity of circumstances and views. The majority were aged 40-49 years, of Pentecostal religion, married, with primary education and 43% were illiterate. All of them practiced peasant farming either full time or part-time.

Methods Qualitative semi-structured face-to-face interviews were conducted in Igbo. The interview guide was based on the self-regulatory model of illness and explored health beliefs. It also included questions to assess perceived needs, socio-demographic characteristics and daily activities of the participants to contextualize the rural Nigerian community. Data saturation was reached after 30 interviews with participants. Pictures, field and reflective notes were taken to supplement the audio data.

Analysis Framework analysis using NVivo software is on-going following these steps: familiarisation, identifying a thematic framework, indexing, charting, and mapping and interpretation of data.

Results Emergent themes from preliminary analysis include:

Social role as a perceived cause or consequence of CLBP Male participants associated CLBP with their occupation and blamed it for their inability to be intimate with their wives. Female participants related CLBP to multiple children and parenting practices and blamed it on their inability to conceive.

CLBP is associated with perceived disadvantage, sense of loss and depression Participants compared their social conditions less favourably with their urban counterparts and explained depression with feelings of tiredness, sadness and shame, as there is no equivalent word for depression in Igbo.

Feelings of helplessness and hopelessness Participants’ feelings of helplessness and hopelessness in the face of their CLBP resulted in their reliance on spiritual sources of support.

Subjective norms determined self-management practices Participants’ self-management practices were driven by perceived social pressure and cultural beliefs.

Conclusions Biological, psychological and social factors are associated with CLBP in this context. Therefore, a quantitative study is being planned to determine the contribution of these factors to disability and quality of life in this rural African context.

Implications Physiotherapy for CLBP in Africa should adopt a more biopsychosocial approach to replace the reductionist biomedical approach.

Keywords Qualitative, Back pain, Self-management Funding

Source/Acknowledgement: University of Nigeria/King’s College London.