‘They were laughing at us and mocking us’: the experiences of people attending a novel behavioural programme for chronic low back pain in a rural Nigerian primary care centre

Problem

Nigeria has one of the greatest burdens of low back pain (LBP), with a one-year prevalence rate of 40-85%, which is greater than 14-51% in other African countries; and a point prevalence rate of 33-40%, which is greater than 10-33% in high income countries. The burden of LBP is disproportionately greater in rural Nigeria with a prevalence rate approaching 85% among rural farmers, a much higher value than the 39% in urban Nigeria. However, there is currently no access to effective treatment of LBP in rural Nigeria. This increases disability, poverty, and rural-urban inequality. Consequently, a novel theory-informed biopsychosocial intervention was developed to target the predictors of chronic LBP disability in rural Nigeria. This is a once weekly six-week community-based group self-management programme that incorporates exercise sessions with discussion sessions informed by cognitive behavioural therapy and motivational interviewing. This study explored the experiences of people attending the programme in a rural primary care centre in Nigeria.

Approach

Structured exit feedback interviews were conducted after programme completion to specifically answer questions important for programme improvement. An open-ended interview guide explored participants’ experiences of the novel programme. Interviews were transcribed verbatim in Igbo. There was forward and back translation of Igbo transcripts. Inductive content analysis was conducted with NVivo version 10. Themes relating to experiences and acceptability of the programme were identified and the number of people reporting these were noted.

Findings

There were 13 adults (10 women; 3 men). Majority were married, middle-aged, farmers, with primary school education.Positive perceptions of the programme and adequate understanding of recommended behaviour change by participants: All but one of the participants viewed the programme positively due to the group structure, being health professional-led, practical demonstration of exercises and postural hygiene, participant perception of improvement in symptoms, provision of information regarding chronic LBP using collaborative communication style. All participants demonstrated adequate understanding of recommended self-management strategies such as exercise, postural hygiene and emotional regulation being ongoing and part of daily life. Negative community perceptions of programme: all participants reported being mocked by community members because they were performing exercises and practising postural hygiene regarded as illegitimate treatment. They reported that their community members regarded pharmacological treatment as the only legitimate means of treating health conditions. This resulted in two participants missing two programme sessions, and five participants concealing that they were coming for the programme to avoid being mocked.

Consequences

Negative community perceptions of non-pharmacological treatment hindered participants’ programme adherence. Behavioural journalism, a social cognitive theory method, may help in promoting the legitimacy of non-pharmacological treatment in this population. This may foster long-term adoption of exercises, postural hygiene, and emotional regulation thereby improving programme effectiveness in this community with entrenched biomedical healthcare model.