A Theoretical Framework for Understanding Patient Decision-Making in Dental Treatment Acceptance in Nigerian Cultural Contexts

Dental treatment acceptance and refusal in Nigerian patients are shaped by cultural beliefs, trust relationships, economic rationality, and religious values that Western decision-making models inadequately capture, and developing an original theoretical framework for dental decision-making in Nigerian contexts represents an important contribution to both clinical dentistry and health behaviour science. This study developed an original theoretical framework for patient dental treatment decision-making in Nigerian cultural contexts, drawing on qualitative theory-building and quantitative validation across four geopolitical zones. A mixed-methods theory-building methodology was employed over 18 months, combining grounded theory qualitative research with 72 dental patients from Kano, Lagos, Enugu, and Port Harcourt (18 per zone), systematic review of health decision-making theory for low-income country settings, and structural equation model validation with 480 dental patients. Grounded theory analysis generated a six-construct theoretical model with Nigeria-specific dimensions: perceived financial barrier, social network advice influence, traditional remedy legitimacy, healthcare provider trust, religious acceptance, and perceived dental system efficacy. Structural equation modelling confirmed the model fit (CFI = 0.94, RMSEA = 0.06). Provider trust was the strongest predictor of treatment acceptance (beta = 0.49, p < 0.001). Social network influence showed stronger effects in northern zone patients. The original Nigerian Dental Treatment Decision Framework provides dentists and policymakers with a culturally grounded model for improving treatment acceptance. Expert review by 20 specialists confirmed the framework's theoretical originality. Keywords: dental treatment decision-making, patient behaviour, Nigerian cultural context, theoretical framework, health behaviour