Psychosocial Determinants of Health-Related Quality of Life Among Adults with Advanced Glaucoma in South South Nigeria: A Mixed-Methods Investigation

Advanced glaucoma is associated with severe visual field loss that profoundly disrupts daily functioning, psychological wellbeing, and social participation. While clinical outcomes of glaucoma management have been extensively studied, psychosocial determinants of health-related quality of life (HRQoL) in advanced glaucoma, particularly in the Nigerian South South zone, remain poorly understood. This study employs a sequential explanatory mixed-methods design across three states in the South South geopolitical zone: Rivers, Delta, and Cross River. Phase one will administer the NEI-VFQ-25, the Hospital Anxiety and Depression Scale (HADS), and a locally adapted social participation inventory to 320 advanced glaucoma patients at tertiary eye centers. Multivariate regression will identify significant predictors of HRQoL. Phase two will conduct 40 in-depth interviews to explore the lived experiences of participants with the lowest HRQoL scores, analyzed using interpretive phenomenological analysis (IPA). The integration of quantitative and qualitative findings will yield a comprehensive explanatory model of psychosocial influences on HRQoL in advanced glaucoma. Original contributions include the development of a regionally validated social participation inventory and the first IPA-grounded account of advanced glaucoma experience in South South Nigeria. Findings will be submitted to state ministries of health and international glaucoma patient advocacy networks. Keywords: quality of life, advanced glaucoma, psychosocial determinants, South South Nigeria, mixed methods