Developing and Testing a Theoretical Framework for Nurse-Led Chronic Disease Management in Primary Health Care Settings in North West Nigeria

Background: Chronic disease burden is escalating in Nigeria while primary health care remains structurally unprepared for long-term condition management. The absence of a contextually grounded theoretical framework limits systematic nurse-led programme development in North West Nigeria. Aim: This study developed and tested a theoretical framework for nurse-led chronic disease management in primary health care settings in Kano and Kaduna States. Methods: A mixed-methods sequential explanatory design was employed in three phases: a systematic review of existing frameworks; qualitative framework development using expert focus groups and key informant interviews; and quantitative testing of the framework using structural equation modelling with survey data from 280 primary care nurses and 340 patients. Confirmatory factor analysis assessed framework validity. Results: A five-domain framework emerged encompassing patient-centred assessment, community-based monitoring, interprofessional coordination, community engagement, and systems enablement. Structural equation modelling confirmed acceptable model fit indices and significant pathway coefficients. Patient outcomes including adherence and symptom control were positively predicted by framework application scores. Conclusion: The framework provides a rigorous, contextually appropriate guide for nurse-led chronic disease management in Nigerian primary health care. It has implications for nursing curriculum development, health policy, and primary care programme design. Keywords: chronic disease management, theoretical framework, primary health care, North West Nigeria, nurse-led care.