Non-specific chronic low back pain in rural Nigeria: A qualitative exploration of beliefs, experiences and self-management practices.

TY - JOUR

T1 - Non-specific chronic low back pain in rural Nigeria: A qualitative exploration of beliefs, experiences and self-management practices.

AU - Igwesi-Chidobe, Nonso

AU - Kitchen, Sheila

AU - Sorinola, Isaac

AU - Godfrey, Emma

PY - 2014/5/19

Y1 - 2014/5/19

N2 - PurposeThis study explored beliefs, experiences and self-management practices of adults living with non-specific chronic low back pain (CLBP) in rural South-Eastern Nigeria. This was in order to identify biopsychosocial factors associated with CLBP to inform the development of a self-management programme for CLBP in rural Nigeria. RelevanceCLBP has a prevalence of around 70% with a vicious cyclical tendency of increasing disability, deepening poverty, reducing quality of life and reinforcing inequality in rural Nigeria. Evidence based guidelines for the management of CLBP advocate a paradigm shift towards a more client-centered approach adopting the biopsychosocial model. 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. Participants30 participants with CLBP were selected by purposive sampling and were screened using the red flags. 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.MethodsQualitative semi-structured face-to-face interviews were conducted in Igbo. The interview guide was based on the self-regulatory model of illness and explored back pain beliefs, coping strategies and appraisals of coping. Data saturation was reached after 30 interviews. Participant observation, Pictures, field and reflective notes were taken to supplement the audio data.AnalysisThematic analysis using Framework approach in NVivo was carried out following these steps: familiarisation, identifying a thematic framework, indexing, charting, mapping and interpretation of data.Results Social construction of CLBP as a disease of hard labour and deprivationParticipants associated their chronic back pain with adversity such as prolonged involvement in manually demanding jobs, poverty, poor nutrition, stress and worry for the future, lack of social support and unfavorable environmental and living conditions. Family strain as a result of perceived impact of CLBP on gender roles Females who had not conceived perceived their lack of success to get pregnant to be due to reduced fertility caused by chronic back pain; males felt the worst effect of their back pain was their reduced ability to be physically intimate with their wives fostering strain in family relationships. Coping by waging war against CLBPParticipants coped with their back pain by ‘escapism from the self’ through increasing activity to avoid thinking. Others coped by concealment, drug dependence or spirituality. Failure of orthodox management led to patronage of alternative healersParticipants felt that orthodox management had failed them because they were inaccessible and ineffective.Unmet expectationsParticipants’ expectations included spiritual healing, temporal healing and the need to modify their livelihood. ConclusionsCLBP in rural Nigeria is a multi-dimensional experience associated with biological, psychological and social factors including biomechanical factors like work posture and lifting, psychological factors such as depression, anxiety, social factors such as socio-economic deprivation and unhelpful cultural beliefs.Implications Physiotherapy for CLBP in Africa should adopt a biopsychosocial approach to replace the reductionist biomedical approach. A community-based physiotherapist-led intervention that is family centered and supported by religious structures may be relevant in rural Africa.KeywordsQualitative, Back pain, Self-management

AB - PurposeThis study explored beliefs, experiences and self-management practices of adults living with non-specific chronic low back pain (CLBP) in rural South-Eastern Nigeria. This was in order to identify biopsychosocial factors associated with CLBP to inform the development of a self-management programme for CLBP in rural Nigeria. RelevanceCLBP has a prevalence of around 70% with a vicious cyclical tendency of increasing disability, deepening poverty, reducing quality of life and reinforcing inequality in rural Nigeria. Evidence based guidelines for the management of CLBP advocate a paradigm shift towards a more client-centered approach adopting the biopsychosocial model. 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. Participants30 participants with CLBP were selected by purposive sampling and were screened using the red flags. 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.MethodsQualitative semi-structured face-to-face interviews were conducted in Igbo. The interview guide was based on the self-regulatory model of illness and explored back pain beliefs, coping strategies and appraisals of coping. Data saturation was reached after 30 interviews. Participant observation, Pictures, field and reflective notes were taken to supplement the audio data.AnalysisThematic analysis using Framework approach in NVivo was carried out following these steps: familiarisation, identifying a thematic framework, indexing, charting, mapping and interpretation of data.Results Social construction of CLBP as a disease of hard labour and deprivationParticipants associated their chronic back pain with adversity such as prolonged involvement in manually demanding jobs, poverty, poor nutrition, stress and worry for the future, lack of social support and unfavorable environmental and living conditions. Family strain as a result of perceived impact of CLBP on gender roles Females who had not conceived perceived their lack of success to get pregnant to be due to reduced fertility caused by chronic back pain; males felt the worst effect of their back pain was their reduced ability to be physically intimate with their wives fostering strain in family relationships. Coping by waging war against CLBPParticipants coped with their back pain by ‘escapism from the self’ through increasing activity to avoid thinking. Others coped by concealment, drug dependence or spirituality. Failure of orthodox management led to patronage of alternative healersParticipants felt that orthodox management had failed them because they were inaccessible and ineffective.Unmet expectationsParticipants’ expectations included spiritual healing, temporal healing and the need to modify their livelihood. ConclusionsCLBP in rural Nigeria is a multi-dimensional experience associated with biological, psychological and social factors including biomechanical factors like work posture and lifting, psychological factors such as depression, anxiety, social factors such as socio-economic deprivation and unhelpful cultural beliefs.Implications Physiotherapy for CLBP in Africa should adopt a biopsychosocial approach to replace the reductionist biomedical approach. A community-based physiotherapist-led intervention that is family centered and supported by religious structures may be relevant in rural Africa.KeywordsQualitative, Back pain, Self-management

KW - Non-specific chronic low back pain; qualitative; self-management

M3 - Meeting abstract

JO - World Confederation for Physical Therapists-African region

JF - World Confederation for Physical Therapists-African region

T2 - World Confederation for Physical Therapy-African Region

Y2 - 19 May 2014 through 23 May 2014

ER -