An Exploration of Self-Care Practice and Factors Influencing Self-Care among People Affected by Leprosy in Nigeria using Social Practice Theory

Udo, Sunday and Limmer, Mark and Von Benzon, Nadia (2022) An Exploration of Self-Care Practice and Factors Influencing Self-Care among People Affected by Leprosy in Nigeria using Social Practice Theory. PhD thesis, Lancaster University.

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Abstract

A social practice theory (SPT) perspective was adopted in this study to explore how leprosy self-care has been practised in a leprosy village in North Central Nigeria. The study contributes to clarifying how SPT assists in improving the knowledge and understanding of the facilitators and barriers to leprosy self-care practice. Although key stakeholders have recommended self-care in improving the quality of life of people affected by leprosy, its implementation has not been effectively sustained, and no study has been conducted in this setting to explain the reasons for this low uptake. This is a hermeneutic phenomenological qualitative study (Vagle, 2018) to explore factors influencing leprosy self-care practice. Data from people affected by leprosy were collected through 20 semi-structured interviews. In addition, over 16 hours of non-participant observation (Baker, 2006) of self-care clinics and self-care groups were carried out. The research aimed to explore participants’ perceptions and experiences of self-care and, at the same time, identify the factors which shape and influence their self-care practice. Data were thematically analysed as described by Braun and Clark (2006). The empirical data indicates that healthcare worker support is critical for sustaining leprosy self-care practice. It also highlights the importance of ensuring leprosy patients have adequate self-care knowledge and skills about leprosy self-care practice. The data analysed reveals that leprosy self-care materials could be subdivided into two broad categories, 'replaceable' and 'irreplaceable' materials. This categorisation highlights the need to ensure that self-care materials are available, affordable, appropriate, and culturally acceptable to people affected by leprosy. An overarching finding of this study is that factors that affect leprosy self-care are dynamic and interconnected and could occur in a continuum conceptualised as the leprosy self-care continuum (LSCC). The LSCC suggests no absolute presence or absence of factors but indicates various degrees of positive (enabler) or negative (inhibitor) influence. This finding informs the need for tailored and individualised leprosy self-care interventions, with continuous monitoring to ensure appropriate responses as the patient’s situation and context change. This thesis argues that leprosy self-care policy should be reconceptualised from changing individual leprosy patient behaviour to modifying broader practices of leprosy self-care. It proposes that leprosy self-care practice from an SPT lens can enhance the experiences of people affected by leprosy by identifying competing and complementary factors to self-care. This research adds a novel theoretical contribution to the broader literature on leprosy self-care by applying SPT (Shove et al., 2012; Shove, 2009) in examining how people affected by leprosy experience self-care daily. Finally, this work makes an empirical contribution to the under-researched field of leprosy self-care (Odia and Omofonmwan, 2013) by extending current thinking on how leprosy self-care is implemented.