Development and Validation of a Contextualised Chronic Disease Self-Management Framework for Family Medicine Practice in Sub-Saharan Africa

Background: Existing chronic disease self-management frameworks are largely developed and validated in high-income country populations and may not adequately account for the sociocultural, economic, and health system contexts of sub-Saharan Africa. This study develops and validates a contextualised self-management framework for use in family medicine practice across the region. Methodology: A sequential mixed-methods design was employed in three phases across Nigeria's six geopolitical zones. Phase one conducted a systematic review and qualitative needs assessment with 48 patients and practitioners. Phase two developed the framework through expert consensus using a modified Delphi process involving 30 family medicine specialists. Phase three piloted the framework with 200 patients across eight family medicine clinics. Results: The Contextualised African Chronic Disease Self-Management Framework incorporated seven empirically grounded domains integrating biomedical, sociocultural, spiritual, and economic dimensions of self-management. Content validity index exceeded 0.85 across all domains. Pilot implementation demonstrated improved patient self-efficacy and medication adherence at three months. Conclusion: This study produces an original theoretically grounded and empirically validated self-management framework tailored to sub-Saharan African family medicine contexts. Its adoption in postgraduate family medicine training curricula would advance patient-centred chronic disease care across the region. Keywords: chronic disease, self-management framework, sub-Saharan Africa, family medicine, validation