Health Literacy, Physical Activity, and Chronic Disease Self-Management Among Older Adults in Rural North Central Nigeria: A Theoretical and Empirical Investigation

Health literacy deficits among older adults in rural Nigeria represent a critical barrier to effective chronic disease self-management and uptake of physical activity as a therapeutic lifestyle behaviour. This dissertation presents a theoretical and empirical investigation of the relationships between health literacy, physical activity, and chronic disease self-management among older adults in rural communities of North Central Nigeria. A mixed-methods design is employed across Plateau, Benue, and Nasarawa States. Quantitative data from 400 adults aged 60 years and above include the Newest Vital Sign health literacy assessment, the Self-Management Behaviour Scale for chronic conditions, and physical activity self-report. Structural equation modelling tests a theoretically derived mediation model in which physical activity mediates the relationship between health literacy and self-management outcomes. Qualitative data from 36 in-depth interviews explore how older adults conceptualise physical activity within their cultural and religious frameworks and identify barriers and facilitators to chronic disease self-management in rural settings. Quantitative findings confirm that health literacy significantly predicts self-management behaviours, partially mediated by physical activity. Oral health education methods and community health worker delivery are identified in the qualitative phase as the most acceptable and effective health literacy intervention channels. The dissertation makes original theoretical contributions by specifying health literacy as an upstream determinant of physical activity in chronic disease populations and provides empirical evidence for rural North Central Nigeria. Keywords: health literacy, physical activity, chronic disease, older adults, rural North Central Nigeria