The Influence of Caste-Equivalent Social Structures and Cultural Determinism on Orthopaedic Healthcare Seeking Behaviour in North West Nigeria: A Critical Ethnographic Study

Healthcare seeking behaviour for orthopaedic conditions in North West Nigeria is shaped by deeply embedded cultural frameworks, social hierarchies, gender norms, and religious beliefs that interact with formal health system factors in ways that quantitative methodologies alone cannot adequately capture. This critical ethnographic study investigates how caste-equivalent social stratification, traditional authority structures, and cultural determinism influence orthopaedic healthcare seeking behaviour among communities in Kano, Sokoto, and Kebbi States, North West Nigeria. Over twenty-four months, extended ethnographic fieldwork including participant observation at compound-level social settings, artisanal worksites, and religious gatherings will be supplemented by forty in-depth interviews with patients, bone setters, community leaders, Quranic school heads, and orthopaedic clinicians. Critical discourse analysis and grounded theory will be used to develop an original theoretical framework explaining the cultural determinants of orthopaedic help-seeking in this population. The study will pay particular attention to the role of Hausa-Fulani social norms around masculinity, female seclusion (purdah), and the religious legitimacy accorded to traditional healing. Findings will challenge deficit-model framings of traditional medicine utilisation by situating community behaviour within its cultural logic. The research outputs will include a peer-reviewed ethnographic monograph, policy briefs for the Kano and Sokoto State Ministries of Health, and a community co-produced educational resource. Keywords: healthcare seeking, ethnography, traditional bone setters, cultural determinism, North West Nigeria.