Developing an Original Theory of Traditional Medicine Integration into Primary Healthcare in Nigeria

Traditional medicine, including herbalism, bonesetters, traditional birth attendants, and spiritual healers, serves as a primary healthcare resource for millions of Nigerians, yet theoretical frameworks for understanding and managing its integration with biomedical primary healthcare services remain underdeveloped in the Nigerian scholarly literature. This study developed an original theory of traditional medicine integration into primary healthcare in Nigeria. A grounded theory methodology was adopted as the primary research approach, supplemented by systematic literature review and expert consultation. Grounded theory fieldwork was conducted over 18 months across six geopolitical zones, with purposive and theoretical sampling yielding 60 in-depth interviews with traditional healers, PHC managers, patients using both systems concurrently, community health workers, and state health officials. Constant comparative analysis and theoretical memo writing generated theoretical categories through iterative analysis. The systematic review of 44 publications on traditional medicine integration in sub-Saharan Africa informed theoretical scope. The resulting substantive theory proposes six original theoretical constructs: concurrent care pluralism (how patients navigate simultaneous biomedical and traditional healthcare), therapeutic legitimacy negotiation (the social process through which traditional healers establish clinical credibility with biomedical counterparts), referral relationship development (the conditions enabling functional referral networks between systems), integration barriers and bridging mechanisms, community health worker role in care navigation, and regulatory boundary maintenance. The original Nigerian Traditional Medicine Integration Theory provides a grounded explanatory account applicable to policy development for formalising traditional medicine-PHC collaboration in Nigeria.

Keywords: traditional medicine integration, primary healthcare, grounded theory, Nigeria, pluralistic healthcare