Theoretical Reconceptualisation of Health Education Practice in Conflict-Affected Communities in North East Nigeria: Toward an Adaptive Framework

Existing theoretical frameworks for health education practice, largely developed in stable, resource-sufficient contexts, inadequately address the complex realities of health education delivery in protracted conflict environments. This study proposes and empirically tests a reconceptualised adaptive framework for health education practice in conflict-affected communities across Borno, Yobe, and Adamawa states in North East Nigeria. A critical realist grounded theory methodology was used, incorporating 48 in-depth interviews with health educators, community health workers, programme managers, and community members, complemented by 12 focus group discussions and 6 months of ethnographic observation across 8 displacement and returnee communities. Constructivist grounded theory analysis, theoretical sampling, and constant comparative methods were applied. The emergent framework conceptualises effective health education in conflict settings as operating across three adaptive dimensions: contextual responsiveness, relational trust building, and iterative knowledge co-production. Traditional prescriptive programme models were consistently inadequate in conditions characterised by displacement, insecurity, and social fragmentation. The study makes an original theoretical contribution to health education scholarship by advancing a conflict-sensitive adaptive health education framework applicable to humanitarian contexts in sub-Saharan Africa. Recommendations include adopting flexible, theory-informed programme models in humanitarian health education policy. Keywords: conflict-affected communities, adaptive health education framework, grounded theory, North East Nigeria, humanitarian health