A Grounded Theory Investigation of Radiographer-Physician Communication Quality and Its Impact on Diagnostic Imaging Outcomes in Nigerian Teaching Hospitals

The quality of communication between radiographers and referring physicians fundamentally shapes the safety, efficiency, and diagnostic accuracy of imaging services, yet the communication processes, barriers, and facilitators in Nigerian teaching hospital radiology departments have not been investigated using a theoretically generative grounded theory methodology. This study conducts an original grounded theory investigation of radiographer-physician communication quality and its impact on diagnostic imaging outcomes in Nigerian teaching hospitals. A constructivist grounded theory design is applied across eight teaching hospitals representing all six geopolitical zones, collecting data through: non-participant observation of 240 radiographer-physician communication interactions in clinical and reporting settings; interpretive interviews with 72 radiographers and 48 clinicians exploring communication experience and impact; and document analysis of referral forms, incident reports, and communication audit records. Constant comparative analysis, theoretical sampling, and saturation procedures generate the substantive theory. The original substantive theory, designated Negotiated Imaging Intelligence, explains how radiographers in Nigerian teaching hospitals strategically manage communication asymmetry with physicians to optimise imaging service outcomes through three core processes: clinical information bridging, imaging expertise assertion, and hierarchical deference calibration. This theory makes an original contribution to the sociology of medical imaging communication by identifying the distinctively asymmetric nature of radiographer-physician communication in Nigerian hierarchical medical cultures, which is absent from existing communication models. Available radiographer-physician communication literature from Nigeria identifies hierarchy and informal communication norms as contextually distinctive features. Keywords: radiographer-physician communication, grounded theory, teaching hospitals, Nigeria, diagnostic imaging outcomes.