Developing an Original Theory of Health Behaviour Change in Low-Literacy Nigerian Communities

Conventional health behaviour change theories, including the Health Belief Model, Theory of Planned Behaviour, and Social Cognitive Theory, were developed in highly literate Western populations and require significant conceptual adaptation for application to low-literacy Nigerian community contexts where decision-making is embedded in social relationships, spiritual frameworks, and communal authority structures. This study developed an original theory of health behaviour change adapted for low-literacy Nigerian communities. A constructive theory-building methodology was employed, combining systematic review, ethnographic primary research, and expert validation. The systematic review evaluated how 42 Nigerian health behaviour change studies operationalised and adapted existing theoretical frameworks, identifying five consistent adaptation gaps: inadequate theorisation of communal versus individual health decisions, spiritual and religious belief integration, informal social network influence pathways, traditional healer-biomedical system navigational behaviour, and the role of shame and honour in health behaviour. The ethnographic component involved 18 months of community observation and 52 in-depth interviews across communities in Zamfara, Anambra, Bayelsa, and Gombe States. Constant comparative analysis generated the core theoretical constructs. The resulting original Communal Health Behaviour Change Theory proposes seven constructs: communal health decision authority, spiritual permission for biomedical care, collective social norm reinforcement, shame regulation as behaviour driver, traditional healer gate-keeping, trusted community voice persuasion, and structural access mediating between intention and action. The theory was validated by 24 health behaviour, anthropology, and community health scholars as an original contribution to global health behaviour theory.

Keywords: health behaviour change, low-literacy communities, Nigeria, behaviour change theory, community health