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

Research output: Contribution to journalMeeting abstractpeer-review


This 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.

CLBP 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.

30 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.

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 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.

Thematic analysis using Framework approach in NVivo was carried out following these steps: familiarisation, identifying a thematic framework, indexing, charting, mapping and interpretation of data.


Social construction of CLBP as a disease of hard labour and deprivation
Participants 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 CLBP
Participants 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 healers
Participants felt that orthodox management had failed them because they were inaccessible and ineffective.

Unmet expectations
Participants’ expectations included spiritual healing, temporal healing and the need to modify their livelihood.

CLBP 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.

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.
Qualitative, Back pain, Self-management
Original languageEnglish
JournalWorld Confederation for Physical Therapists-African region
Publication statusPublished - 19 May 2014
EventWorld Confederation for Physical Therapy-African Region - , United Kingdom
Duration: 19 May 201423 May 2014


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


Dive into the research topics of 'Non-specific chronic low back pain in rural Nigeria: A qualitative exploration of beliefs, experiences and self-management practices.'. Together they form a unique fingerprint.

Cite this