Original Theoretical Framework for Understanding Socio-Cultural Determinants of Medication Adherence in Chronic Disease Management in Northern Nigeria

Background: Existing theoretical models of medication adherence, predominantly developed in Western contexts, inadequately capture the socio-cultural complexity of adherence behaviour in Northern Nigeria, where religious belief systems, gender dynamics, traditional healing practices, and extended family structures profoundly shape health decisions. This research develops and validates an original theoretical framework specifically contextualised to Northern Nigerian chronic disease patients. Methods: A grounded theory approach was adopted using data from 80 in-depth interviews and 12 focus group discussions with chronic disease patients (hypertension, diabetes, epilepsy) across Kano, Sokoto, Borno, and Adamawa states. Data were analysed using Strauss and Corbin's constructivist grounded theory procedures. Member checking and expert panel review ensured trustworthiness. Emerging theoretical categories were synthesised into a formal framework model. Results: Five core theoretical categories emerged: faith-mediated health locus of control, elder authority in treatment decisions, oscillation between biomedical and traditional healing, economic sacrifice hierarchy in drug purchasing, and pharmacy as social trust space. These categories interconnect in a dynamic relational model that predicts adherence trajectories distinct from existing frameworks. Conclusion: This grounded theory framework offers an original, empirically derived explanation of adherence behaviour in Northern Nigeria, with direct utility for designing culturally adapted pharmaceutical care interventions and national chronic disease policies. Keywords: medication adherence, grounded theory, Northern Nigeria, socio-cultural determinants, chronic disease