Theoretical Framework for Pharmacist-Led Chronic Disease Management in Nigeria: Integrating Capability, Opportunity, and Motivation Constructs Across Geopolitical Zones

Chronic disease management represents the foremost healthcare challenge of the twenty-first century in Nigeria, yet the theoretical foundations underpinning pharmacist-led interventions in this domain remain underdeveloped and geographically biased. This study developed and tested an integrated theoretical framework for pharmacist-led chronic disease management applicable across Nigeria's six geopolitical zones by employing the Capability-Opportunity-Motivation-Behaviour model as its organizing architecture. A multi-phase sequential mixed-methods design was adopted, beginning with systematic review and meta-analysis of existing Nigerian pharmacist intervention studies, followed by grounded theory qualitative fieldwork in twelve purposively selected sites spanning all geopolitical zones, and concluding with structural equation modelling of quantitative survey data from 540 pharmacists and 1,200 chronic disease patients. Grounded theory analysis produced a contextualized model where capability is constituted by pharmacogenomics literacy, motivational interviewing skills, and clinical decision-making confidence; opportunity is shaped by health system architecture, referral pathway formalization, and digital health infrastructure; and motivation is driven by professional identity, peer recognition, and patient outcome feedback. Structural equation modelling confirmed adequate fit indices and supported all major hypothesized pathways. Significant cross-zonal variation was observed in opportunity constructs, reflecting infrastructural disparities. The framework provides a replicable, theoretically grounded blueprint for designing, implementing, and evaluating pharmacist-led chronic disease programs across Nigeria's diverse healthcare contexts. Policymakers and pharmacy educators are urged to adopt this framework in national pharmacy practice development planning. Keywords: theoretical framework, chronic disease management, pharmacist-led care, Capability-Opportunity-Motivation model, Nigeria