Theoretical Modelling of Integrated Care Pathways for Non-Communicable Disease Management in Nigerian Primary Healthcare: A Grounded Theory Approach

Background: Integrated care pathways represent a potentially transformative organisational strategy for addressing the fragmented management of non-communicable diseases in Nigeria's primary healthcare system. Existing frameworks are largely derived from high-income settings and require theoretical reformulation for the Nigerian context. This study develops a grounded theory model of integrated care pathway implementation in Nigerian primary healthcare. Methodology: A constructivist grounded theory design was employed across six geopolitical zones, enrolling 60 key informants including family medicine specialists, health system managers, policy makers, and patients through theoretical sampling. Constant comparative analysis and memo writing iteratively refined emerging categories. Theoretical saturation guided data collection cessation. Results: A contextualised model of integrated care emerged, grounded in the concept of relational navigation, wherein family medicine practitioners serve as anchors within a network of community, facility, and policy actors. Trust, protocol standardisation, and digital health readiness were identified as core theoretical constructs mediating pathway effectiveness. Conclusion: The grounded theory model produced contributes an original theoretical framework for integrated NCD care that is culturally and structurally responsive to Nigerian primary care realities. This framework provides a foundation for evidence-informed policy reform and residency curriculum development in family medicine. Keywords: integrated care, non-communicable diseases, grounded theory, primary healthcare, Nigeria